AB0438 Clinical features of pneumocystis pneumonia in patients with rheumatoid arthritis, in comparison with pneumocystis pneumonia in acquired immunodeficiency syndrome. (23rd January 2014)

• Record Type: Journal Article
• Authors: Nunokawa, T.; Ohashi, K.; Sugii, S.; Shimada, K.; Yokogawa, N.
• Is Part Of: Annals of the rheumatic diseases. Volume 71(2012)Supplement 3
• Page Start: 662
• Page End: 662
• Publication Date: 2014-01-23
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2012-eular.438
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Pneumocystis pneumonia (PCP) is rare, but life-threatening complications in patients with rheumatoid arthritis (RA). PCP in RA exhibits differently from PCP in acquired immunodeficiency syndrome (AIDS). Objectives: The aim of this study is to reveal clinical and laboratory differences between PCP in patients with RA and PCP in AIDS. Methods: We reviewed electric chart of our hospital from 1/2006 to 12/2011. PCP was difined by the following criteria a) symptoms and radiological findings compatible with PCP b) detection of P. jirovecii by polymerase chain reaction (PCR) in respiratory specimens, c) elevated plasma (1$→ $3)-β-D-glucan level. We compared the clinical features between RA patients and AIDS patients. Results: Forty-one patients were diagnosed with PCP: 15 with RA, 10 with AIDS, 8 with connective tissue disease (CTD), 3 with cancer, 5 with others. In RA patients, 6 patients were on biologic therapy with or without low dose prednisolone. Seven patients were treated with low dose prednisolone and non-biologic DMARDs: 5 on methotrexate, 2 on methotrexate and tacrolimus, and 2 on steroids alone. Positivity of Grocott stain in RA patients was significantly lower than that in AIDS patients (7.1% vs 77.8%, p =0.0005). Serum LDH and CRP in RA patients were significantly higher than those in AIDS patients ( p =0.04 and p =0.004, respectively). Three in RA patients died while none in AIDS patients. Conclusions: In RA patients, low dose steroids or DMARDs can induce PCP and PCR method should be used to detect P. jirovecii . We speculate PCP in RA patients may have more intense inflammation with less parasite burden and, as a result, worse prognosis than PCP in AIDS patients Disclosure of Interest: None Declared