{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:44:21Z","timestamp":1792172661394,"version":"4.4.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2014,2,5]],"date-time":"2014-02-05T00:00:00Z","timestamp":1391558400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2014,2,5]],"date-time":"2014-02-05T00:00:00Z","timestamp":1391558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthritis Res Ther"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p><jats:italic>Pneumocystis<\/jats:italic> pneumonia (PCP) is one of the most prevalent opportunistic infections in patients undergoing immunosuppressive therapy. In this article, we discuss risk factors for PCP development in patients with rheumatoid arthritis (RA) during the course of biologic therapy and describe a prophylactic treatment for PCP with trimethoprim\/sulfamethoxazole (TMP\/SMX). We also evaluate the effectiveness and safety of the treatment.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>We retrospectively analyzed 702 RA patients who received biologic therapy and compared the characteristics of patients with vs. without PCP to identify the risk factors for PCP. Accordingly, we analyzed 214 patients who received the TMP\/SMX biologic agents as prophylaxis against PCP at the start of treatment to evaluate their effectiveness and safety.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>We identified the following as risk factors for PCP: age at least 65\u00a0years (hazard ratio (HR)\u2009=\u20094.37, 95% confidence interval (CI)\u2009=\u20091.04 to 18.2), coexisting pulmonary disease (HR\u2009=\u20098.13, 95% CI\u2009=\u20091.63 to 40.0), and use of glucocorticoids (HR\u2009=\u200911.4, 95% CI\u2009=\u20091.38 to 90.9). We employed a protocol whereby patients with two or three risk factors for PCP would receive prophylactic treatment. In the study with 214 patients, there were no cases of PCP, and the incidence of PCP was reduced to 0.00 per 100 person-years compared with that before the procedure (0.93 per 100 person-years). There were no severe adverse events induced by the TMP\/SMX treatment.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusions<\/jats:title>\n                        <jats:p>RA patients with two or three risk factors for PCP who are receiving biologic therapy can benefit from safe primary prophylaxis.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/ar4472","type":"journal-article","created":{"date-parts":[[2014,2,5]],"date-time":"2014-02-05T10:04:16Z","timestamp":1391594656000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Prophylaxis for Pneumocystis pneumonia in patients with rheumatoid arthritis treated with biologics, based on risk factors found in a retrospective study"],"prefix":"10.1186","volume":"16","author":[{"given":"Takayuki","family":"Katsuyama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuyoshi","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kubo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masao","family":"Nawata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2014,2,5]]},"reference":[{"key":"4142_CR1","doi-asserted-by":"publisher","first-page":"343","DOI":"10.3109\/s10165-010-0406-3","volume":"21","author":"T Koike","year":"2011","unstructured":"Koike T, Harigai M, Inokuma S, Ishiguro N, Ryu J, Takeuchi T, Tanaka Y, Yamanaka H, Fujii K, Yoshinaga T, Freundlich B, Suzukawa M: Postmarketing surveillance of safety and effectiveness of etanercept in Japanese patients with rheumatoid arthritis. Mod Rheumatol. 2011, 21: 343-351. 10.3109\/s10165-010-0406-3.","journal-title":"Mod Rheumatol"},{"key":"4142_CR2","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1002\/1529-0131(199904)42:4<780::AID-ANR23>3.0.CO;2-M","volume":"42","author":"MM Ward","year":"1999","unstructured":"Ward MM, Donald F: Pneumocystis carinii pneumonia in patients with connective tissue disease: the role of hospital experience in diagnosis and mortality. Arthritis Rheum. 1999, 42: 780-789. 10.1002\/1529-0131(199904)42:4<780::AID-ANR23>3.0.CO;2-M.","journal-title":"Arthritis Rheum"},{"key":"4142_CR3","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.2169\/naika.78.1293","volume":"78","author":"K Takabayashi","year":"1989","unstructured":"Takabayashi K, Koike T, Kurasawa K, Yamazaki S, Sugiyama T, Matsumura R, Yoshida H, Tomioka H, Yoshida S, Oshima H: [Pulmonary opportunistic infections in patients with autoimmune diseases] [in Japanese]. Nihon Naika Gakkai Zasshi. 1989, 78: 1293-1298. 10.2169\/naika.78.1293.","journal-title":"Nihon Naika Gakkai Zasshi"},{"key":"4142_CR4","first-page":"289","volume":"13","author":"CF Thomas Jr","year":"1998","unstructured":"Thomas CF, Limper AH: Pneumocystis pneumonia: clinical presentation and diagnosis in patients with and without acquired immune deficiency syndrome. Semin Respir Infect. 1998, 13: 289-295.","journal-title":"Semin Respir Infect"},{"key":"4142_CR5","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1097\/00054725-200409000-00025","volume":"10","author":"FS Velayos","year":"2004","unstructured":"Velayos FS, Sandborn WJ: Pneumocystis carinii pneumonia during maintenance anti-tumor necrosis factor-\u03b1 therapy with infliximab for Crohn\u2019s disease. Inflamm Bowel Dis. 2004, 10: 657-660. 10.1097\/00054725-200409000-00025.","journal-title":"Inflamm Bowel Dis"},{"key":"4142_CR6","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1097\/00054725-200407000-00017","volume":"10","author":"M Seddik","year":"2004","unstructured":"Seddik M, Meliez H, Seguy D, Viget N, Cortot A, Colombel JF: Pneumocystis jirovecii (carinii) pneumonia following initiation of infliximab and azathioprine therapy in a patient with Crohn\u2019s disease. Inflamm Bowel Dis. 2004, 10: 436-437. 10.1097\/00054725-200407000-00017.","journal-title":"Inflamm Bowel Dis"},{"key":"4142_CR7","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1023\/B:DDAS.0000042246.58984.98","volume":"49","author":"N Kaur","year":"2004","unstructured":"Kaur N, Mahl TC: Pneumocystis carinii pneumonia with oral candidiasis after infliximab therapy for Crohn\u2019s disease. Dig Dis Sci. 2004, 49: 1458-1460.","journal-title":"Dig Dis Sci"},{"key":"4142_CR8","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1136\/ard.2007.072967","volume":"67","author":"T Takeuchi","year":"2008","unstructured":"Takeuchi T, Tatsuki Y, Nogami Y, Ishiguro N, Tanaka Y, Yamanaka H, Kamatani N, Harigai M, Ryu J, Inoue K, Kondo H, Inokuma S, Ochi T, Koike T: Postmarketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis. Ann Rheum Dis. 2008, 67: 189-194. 10.1136\/ard.2007.072967.","journal-title":"Ann Rheum Dis"},{"key":"4142_CR9","doi-asserted-by":"publisher","first-page":"5","DOI":"10.4065\/71.1.5","volume":"71","author":"SH Yale","year":"1996","unstructured":"Yale SH, Limper AH: Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. 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