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Pneumocystis jirovecii pneumonia in autoimmune rheumatic diseases: a nationwide population-based study

التفاصيل البيبلوغرافية
العنوان: Pneumocystis jirovecii pneumonia in autoimmune rheumatic diseases: a nationwide population-based study
المؤلفون: Pei I. Kuo, Yu Sheng Chang, Chi Sheng Chiou, Wei Sheng Chen, Tzu Min Lin, Li Fang Hu, Chi Ching Chang, Kai Len Tsai, Yi Chun Lin, Tsung Yun Hou, Jin Hua Chen, Lung Fang Chen, Sheng Hong Lin, Hui Ching Hsu
المصدر: Clinical Rheumatology
بيانات النشر: Springer Science and Business Media LLC, 2021.
سنة النشر: 2021
مصطلحات موضوعية: Male, medicine.medical_specialty, Population, Pneumocystis carinii, Autoimmune Diseases, Arthritis, Rheumatoid, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Rheumatic Diseases, Internal medicine, medicine, Mycophenolate, Humans, Lupus Erythematosus, Systemic, 030212 general & internal medicine, Risk factor, education, Cyclophosphamide, Steroid, Aged, 030203 arthritis & rheumatology, education.field_of_study, business.industry, Proportional hazards model, Pneumonia, Pneumocystis, Hazard ratio, Autoimmune rheumatic diseases, General Medicine, Dermatomyositis, medicine.disease, Pneumocystis jirovecii pneumonia, Rheumatoid arthritis, Original Article, business, Systemic vasculitis
الوصف: Objective To compare Pneumocystis jirovecii pneumonia (PJP) risk between patients with autoimmune rheumatic diseases (ARD) and the general population Methods We 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. Results We 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. Conclusion Underlying 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.
تدمد: 1434-9949
0770-3198
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9575e84a37382f1d41225db96aa7909e
https://doi.org/10.1007/s10067-021-05660-4
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....9575e84a37382f1d41225db96aa7909e
قاعدة البيانات: OpenAIRE
الوصف
تدمد:14349949
07703198