We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America.
- Authors
Sabbagh, Sara E; Neely, Jessica; Chow, Albert; DeGuzman, Marietta; Lai, Jamie; Lvovich, Svetlana; McGrath, Tara; Pereira, Maria; Pinal-Fernandez, Iago; Roberts, Jordan; Rouster-Stevens, Kelly; Schmeling, Heinrike; Sura, Anjali; Tarshish, Gabriel; Tucker, Lori; Rider, Lisa G; Kim, Susan; Group, for the CARRA JDM Workgroup and the Childhood Myositis Heterogeneity Study
- Abstract
Objectives Pneumocystis jirovecii pneumonia (PJP) is associated with significant morbidity and mortality in adult myositis patients; however, there are few studies examining PJP in juvenile myositis [juvenile idiopathic inflammatory myopathy (JIIM)]. The purpose of this study was to determine the risk factors and clinical phenotypes associated with PJP in JIIM. Methods An research electronic data capture (REDCap) questionnaire regarding myositis features, disease course, medications and PJP infection characteristics was completed by treating physicians for 13 JIIM patients who developed PJP (PJP+) from the USA and Canada. Myositis features and medications were compared with 147 JIIM patients without PJP (PJP–) from similar geographic regions who enrolled in National Institutes of Health natural history studies. Results PJP+ patients were more often of Asian ancestry than PJP– patients [odds ratio (OR) 8.7; 95% CI 1.3, 57.9]. Anti- melanoma differentiation associated protein 5 (MDA5) autoantibodies (OR 12.5; 95% CI 3.0, 52.4), digital infarcts (OR 43.8; 95% CI 4.2, 460.2), skin ulcerations (OR 12.0; 95% CI 3.5, 41.2) and interstitial lung disease (OR 10.6; 95% CI 2.1, 53.9) were more frequent in PJP+ patients. Before PJP diagnosis, patients more frequently received pulse steroids, rituximab and more immunosuppressive therapy compared with PJP– patients. Seven PJP+ patients were admitted to the intensive care unit and four patients died due to PJP or its complications. Conclusions PJP is a severe infection in JIIM that can be associated with mortality. Having PJP was associated with more immunosuppressive therapy, anti-MDA5 autoantibodies, Asian race and certain clinical features, including digital infarcts, cutaneous ulcerations and interstitial lung disease. Prophylaxis for PJP should be considered in juvenile myositis patients with these features.
- Subjects
NORTH America; AUTOANTIBODIES; COMPARATIVE studies; CONFIDENCE intervals; INTERSTITIAL lung diseases; MYOSITIS; PNEUMOCYSTIS pneumonia; QUESTIONNAIRES; PHENOTYPES; ODDS ratio; SKIN ulcers; DISEASE risk factors
- Publication
Rheumatology, 2021, Vol 60, Issue 2, p829
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/keaa436