ArticleClinical rheumatology2021
Pneumocystis jirovecii pneumonia in autoimmune rheumatic diseases: a nationwide population-based study.
Article in Clinical rheumatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed, 48 citations in OpenAlex.
- Pathogens in rheumatoid arthritis: epidemiological, mechanistic, and clinical insights.Biomarker research · 2026Review
- Risk management plan adherence and clinical outcomes in patients receiving targeted therapies.Clinical rheumatology · 2026Observational
- [Treatment principles and long-term management of glomerulonephritides].Innere Medizin (Heidelberg, Germany) · 2026Review
- Clinical characteristics and long-term prognosis of anti-MDA5-positive dermatomyositis: a comparative study across age groups.Orphanet journal of rare diseases · 2026Article
- Modulation of host lung immunity in Pneumocystis pneumonia: a review of current concepts and future prospects for novel adjunctive immune-based therapies.Journal of immunology (Baltimore, Md. : 1950) · 2026Review
- Outcomes and Trends of Pneumocystis Pneumonia in hospitalized patients with autoimmune diseases: Insights from the National Inpatient Sample.Advances in rheumatology (London, England) · 2025Article
- Invasive fungal infections in patients with rheumatoid arthritis: an explorative analysis from the German RABBIT register.RMD open · 2025Article
- Pneumocystis Pneumonia in Cirrhosis: An Underrecognized Fungal Infection in a Vulnerable Host.Journal of fungi (Basel, Switzerland) · 2025Article
- Diagnostic value of bronchoalveolar lavage fluid metagenomic next-generation sequencing for pulmonary infections in patients with connective tissue disease: A retrospective study.Scientific reports · 2025Article
- Diagnosis ofInfection & chemotherapy · 2025Review
- Abrupt Breathlessness: Pneumocystis jirovecii Pneumonia Associated with Inebilizumab in Neuromyelitis Optica Spectrum Disorder: A Case Report and Literature Review.Infection and drug resistance · 2025Article
- Opportunistic Infections, Mortality Risk, and Prevention Strategies in Patients With Vacuoles, E1 Enzyme, X-Linked, Autoinflammatory, Somatic (VEXAS) Syndrome.Open forum infectious diseases · 2024Article
- Diagnosis and management of autoimmune diseases in the ICU.Intensive care medicine · 2024Review
- Pneumocystis jirovecii pneumonia increases the 3-months mortality of anti-MDA5-antibody-positive dermatomyositis patients.Frontiers in immunology · 2024Observational
- Association Between Mycophenolate Mofetil Use and Subsequent Infections Among Hospitalized Patients with Systemic Lupus Erythematosus: A Nested Case-Control Study.Rheumatology and therapy · 2023Article
- Position statement on infection screening, prophylaxis, and vaccination in pediatric patients with rheumatic diseases and immunosuppressive therapies, part 2: infection prophylaxis.European journal of pediatrics · 2023Article
- Perspectives on Mycophenolate Mofetil in the Management of Autoimmunity.Clinical reviews in allergy & immunology · 2023Review
- Invasive fungal diseases in patients with autoimmune diseases: a case series from the French RESSIF network.RMD open · 2023Article
- Trends in the Epidemiology ofJournal of fungi (Basel, Switzerland) · 2023Review
- Rapidly progressive interstitial lung disease combined with pneumocystis jiroveci pneumonia in a patient with single anti-TIF-1γ antibody positive dermatomyositis in the context of an underlying tumor.BMC pulmonary medicine · 2023Article
Corrections and comments
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Authors and funding
14 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare Pneumocystis jirovecii pneumonia (PJP) risk between patients with autoimmune rheumatic diseases (ARD) and the general population
methodsWe identified patients with ARD recorded in the National Health Insurance Research Database of Taiwan from 2002 to 2015 and randomly selected a comparison cohort from the general population matched for age and sex. We analyzed PJP risk stratified by sex, age, comorbidities, and medications using Cox proportional hazard model.
resultsWe enrolled 103,117 patients with ARD. PJP risk significantly increased in patients with any ARD and with each individual ARD like rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren's syndrome (SjS), polymyositis and dermatomyositis (PM/DM), systemic sclerosis (SSc), and systemic vasculitis. Patients with PM/DM showed prominent risk with incidence rate of 12.47/100,000 patient year (95% confidence interval (CI), 32.16-86.70). In a time-dependent Cox proportional hazard model with comorbidities and medications as covariates, PM/DM, SSc, SLE, and SjS significantly increased adjusted hazard ratios (aHR) of 5.40, 5.12, 4.09, and 3.64, respectively (95% CI of 2.82-10.35, 2.16-12.13, 2.41-6.95, and 2.06-6.42, respectively). AHR after adjusting for male sex, cancer, human immunodeficiency virus infection (HIV), and interstitial lung disease also significantly increased. Use of daily oral steroid dose of >10 mg conferred the highest risk followed by mycophenolate. Use of injected steroids, cyclophosphamide, biological agents, methotrexate, and cyclosporine conferred a significantly higher risk.
conclusionUnderlying ARD significantly predisposes patients to PJP, with PM/DM posing the highest threat. In addition to underlying disease, comorbidities and concomitant immunosuppressants are major risks. The strongest risk is recent daily steroid dose of >10 mg. Mycophenolate seems to be a more prominent risk factor than cyclophosphamide. Key Points • Autoimmune rheumatic diseases (ARD) significantly increased the overall risk of PJP, and so did each individual ARD. • Use of steroids, mycophenolate, cyclophosphamide, biological agents, methotrexate, and cyclosporine all significantly increased risk of PJP. • Male, elderly, malignancy, HIV, and interstitial lung disease are also related to increased risk of PJP. • Underlying ARD, comorbidities, and use of immunosuppressant should all be considered in determining the overall risk of PJP.
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