Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: A retrospective review and case-control study of 21 patients

Yukiko Komano, Masayoshi Harigai, Ryuji Koike, Haruhito Sugiyama, J. U N Ogawa, Kazuyoshi Saito, Naoya Sekiguchi, Masayuki Inoo, Ikuko Onishi, Hiroyuki Ohashi, Fujio Amamoto, Masayuki Miyata, Hideo Ohtsubo, Kazuko Hiramatsu, Masahiro Iwamoto, Seiji Minota, Naoki Matsuoka, Goichi Kageyama, Kazuyoshi Imaizumi, Hitoshi TokudaYasumi Okochi, Koichiro Kudo, Yoshiya Tanaka, Tsutomu Takeuchi, Nobuyuki Miyasaka

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Abstract

Objective. To establish proper management of Pneumocystis jiroveci pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with infliximab. PCP has been observed in 0.4% of patients with RA treated with infliximab in Japan. Methods. Data from patients with RA (n = 21) who were diagnosed with PCP during infliximab treatment and from 102 patients with RA who did not develop PCP during infliximab therapy were collected from 14 rheumatology referral centers in Japan. A retrospective review of these patients and a case-control study to compare patients with and without PCP were performed. Results. The median length of time from the first infliximab infusion to the development of PCP was 8.5 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 7.5 mg/day and 8 mg/week, respectively. Pneumocystis jiroveci was microscopically identified in only 2 patients, although the polymerase chain reaction test for the organism was positive in 20 patients. The patients with PCP had significantly lower serum albumin levels (P < 0.001) and lower serum IgG levels (P < 0.001) than the patients without PCP. Computed tomography of the chest in all patients with PCP revealed ground-glass opacity either with sharp demarcation by interlobular septa or without interlobular septal boundaries. Sixteen of the 21 patients with PCP developed acute respiratory failure, but all survived. Conclusion. PCP is a serious complication that may occur early in the course of infliximab therapy in patients with RA. For the proper clinical management of this infectious disease, physicians need to be aware of the possibility of PCP developing during infliximab therapy.

Original languageEnglish
Pages (from-to)305-312
Number of pages8
JournalArthritis Care and Research
Volume61
Issue number3
DOIs
Publication statusPublished - 2009 Mar 15
Externally publishedYes

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Pneumocystis carinii
Pneumocystis Pneumonia
Case-Control Studies
Rheumatoid Arthritis
Infliximab
Japan
Rheumatology
Therapeutics
Prednisolone
Methotrexate
Serum Albumin
Respiratory Insufficiency

ASJC Scopus subject areas

  • Rheumatology

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Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab : A retrospective review and case-control study of 21 patients. / Komano, Yukiko; Harigai, Masayoshi; Koike, Ryuji; Sugiyama, Haruhito; Ogawa, J. U N; Saito, Kazuyoshi; Sekiguchi, Naoya; Inoo, Masayuki; Onishi, Ikuko; Ohashi, Hiroyuki; Amamoto, Fujio; Miyata, Masayuki; Ohtsubo, Hideo; Hiramatsu, Kazuko; Iwamoto, Masahiro; Minota, Seiji; Matsuoka, Naoki; Kageyama, Goichi; Imaizumi, Kazuyoshi; Tokuda, Hitoshi; Okochi, Yasumi; Kudo, Koichiro; Tanaka, Yoshiya; Takeuchi, Tsutomu; Miyasaka, Nobuyuki.

In: Arthritis Care and Research, Vol. 61, No. 3, 15.03.2009, p. 305-312.

Research output: Contribution to journalArticle

Komano, Y, Harigai, M, Koike, R, Sugiyama, H, Ogawa, JUN, Saito, K, Sekiguchi, N, Inoo, M, Onishi, I, Ohashi, H, Amamoto, F, Miyata, M, Ohtsubo, H, Hiramatsu, K, Iwamoto, M, Minota, S, Matsuoka, N, Kageyama, G, Imaizumi, K, Tokuda, H, Okochi, Y, Kudo, K, Tanaka, Y, Takeuchi, T & Miyasaka, N 2009, 'Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: A retrospective review and case-control study of 21 patients', Arthritis Care and Research, vol. 61, no. 3, pp. 305-312. https://doi.org/10.1002/art.24283
Komano, Yukiko ; Harigai, Masayoshi ; Koike, Ryuji ; Sugiyama, Haruhito ; Ogawa, J. U N ; Saito, Kazuyoshi ; Sekiguchi, Naoya ; Inoo, Masayuki ; Onishi, Ikuko ; Ohashi, Hiroyuki ; Amamoto, Fujio ; Miyata, Masayuki ; Ohtsubo, Hideo ; Hiramatsu, Kazuko ; Iwamoto, Masahiro ; Minota, Seiji ; Matsuoka, Naoki ; Kageyama, Goichi ; Imaizumi, Kazuyoshi ; Tokuda, Hitoshi ; Okochi, Yasumi ; Kudo, Koichiro ; Tanaka, Yoshiya ; Takeuchi, Tsutomu ; Miyasaka, Nobuyuki. / Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab : A retrospective review and case-control study of 21 patients. In: Arthritis Care and Research. 2009 ; Vol. 61, No. 3. pp. 305-312.
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T2 - A retrospective review and case-control study of 21 patients

AU - Komano, Yukiko

AU - Harigai, Masayoshi

AU - Koike, Ryuji

AU - Sugiyama, Haruhito

AU - Ogawa, J. U N

AU - Saito, Kazuyoshi

AU - Sekiguchi, Naoya

AU - Inoo, Masayuki

AU - Onishi, Ikuko

AU - Ohashi, Hiroyuki

AU - Amamoto, Fujio

AU - Miyata, Masayuki

AU - Ohtsubo, Hideo

AU - Hiramatsu, Kazuko

AU - Iwamoto, Masahiro

AU - Minota, Seiji

AU - Matsuoka, Naoki

AU - Kageyama, Goichi

AU - Imaizumi, Kazuyoshi

AU - Tokuda, Hitoshi

AU - Okochi, Yasumi

AU - Kudo, Koichiro

AU - Tanaka, Yoshiya

AU - Takeuchi, Tsutomu

AU - Miyasaka, Nobuyuki

PY - 2009/3/15

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N2 - Objective. To establish proper management of Pneumocystis jiroveci pneumonia (PCP) in rheumatoid arthritis (RA) patients treated with infliximab. PCP has been observed in 0.4% of patients with RA treated with infliximab in Japan. Methods. Data from patients with RA (n = 21) who were diagnosed with PCP during infliximab treatment and from 102 patients with RA who did not develop PCP during infliximab therapy were collected from 14 rheumatology referral centers in Japan. A retrospective review of these patients and a case-control study to compare patients with and without PCP were performed. Results. The median length of time from the first infliximab infusion to the development of PCP was 8.5 weeks. At the onset of PCP, the median dosages of prednisolone and methotrexate were 7.5 mg/day and 8 mg/week, respectively. Pneumocystis jiroveci was microscopically identified in only 2 patients, although the polymerase chain reaction test for the organism was positive in 20 patients. The patients with PCP had significantly lower serum albumin levels (P < 0.001) and lower serum IgG levels (P < 0.001) than the patients without PCP. Computed tomography of the chest in all patients with PCP revealed ground-glass opacity either with sharp demarcation by interlobular septa or without interlobular septal boundaries. Sixteen of the 21 patients with PCP developed acute respiratory failure, but all survived. Conclusion. PCP is a serious complication that may occur early in the course of infliximab therapy in patients with RA. For the proper clinical management of this infectious disease, physicians need to be aware of the possibility of PCP developing during infliximab therapy.

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