Prognostic Factors Affecting Death in Patients with Rheumatoid Arthritis Complicated by Pneumocystis jirovecii Pneumonia and One-Year Clinical Course: The ANSWER Cohort Study

Int J Mol Sci. 2023 Apr 17;24(8):7399. doi: 10.3390/ijms24087399.

Abstract

This multicenter retrospective study aimed to clarify the prognostic factors for mortality and changes in treatment modalities and disease activities after the onset of Pneumocystis jirovecii pneumonia (PCP) in patients with rheumatoid arthritis (RA). Data regarding the clinical background, treatment modalities, and disease activity indicators of RA at the onset of PCP (baseline), and 6 months and 12 months after treatment were extracted. Of the 37 patients with RA-PCP (median age, 69 years; 73% female), chemical prophylaxis was administered to 8.1%. Six patients died during PCP treatment. The serum C-reactive protein (CRP) levels and the prednisolone (PDN) dose at baseline in the PCP death group were significantly higher than those in the survivor group. Multivariate analysis using a Cox regression model showed that PDN dose at baseline was a predictor of death from PCP in patients with RA. During the 12 months from baseline, the RA disease activity significantly decreased. A high dose of corticosteroids for RA may result in a poor prognosis when PCP is complicated. In the future, preventive administration techniques must be established for patients with RA who need PCP prevention.

Keywords: Pneumocystis jirovecii pneumonia; prognosis; rheumatoid arthritis.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Arthritis, Rheumatoid* / complications
  • Arthritis, Rheumatoid* / drug therapy
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Pneumocystis carinii*
  • Pneumonia, Pneumocystis* / complications
  • Pneumonia, Pneumocystis* / drug therapy
  • Prednisolone / therapeutic use
  • Prognosis
  • Retrospective Studies

Substances

  • Prednisolone

Grants and funding

This study reported in this publication used the ANSWER Cohort, supported by grants from 11 pharmaceutical companies (AbbVie GK, Asahi Kasei, Ayumi, Chugai, Eisai, Eli Lilly Japan K.K, Janssen K.K, Ono, Sanofi K.K, Teijin Healthcare, and UCB Japan) and an information technology services company (CAC). This was an investigator-initiated study. These companies had no roles in the study design, data collection, data analysis, data interpretation, or writing of the report.