Recommendations for the management of pulmonary fungal infections in patients with rheumatoid arthritis.

Abstract

Often life-threatening pulmonary fungal infections (PFIs) can occur in patients with rheumatoid arthritis (RA) receiving disease-modifying anti-rheumatic drugs (DMARDs). Most of the data concerning PFIs in RA patients come from case reports and retrospective case series. Of the ve most widely described PFIs, Pneumocystis jirovecii pneumonia (PJP) has rarely been seen outside Japan, pulmonary cryptococcosis has been diagnosed in only a small number of patients worldwide, pulmonary coccidioidomycosis has almost only been observed in endemic areas, the limited number of cases of pulmonary histoplasmosis have mainly occurred in the USA, and the rare cases of invasive pulmonary aspergillosis have only been encountered in leukopenic patients. Many aspects of the prophylaxis, diagnosis and treatment of PFIs in RA patients remain to be defined, as does the role of each DMARD in increasing the risk of infection, and the possibility of resuming biological and non-biological DMARD treatment after the infection has been cured. The recommendations for the management of PFIs described in this paper are the product of a consensus procedure promoted by the Italian group for the Study and Management of Infections in Patients with Rheumatic Diseases (the ISMIR group).

• Authors: Massimo Galli, Spinello Antinori, Fabiola Atzeni, Luca Meroni, Agostino Riva, Carlo Scirè, Fulvio Adorni, Luca Quartuccio, Marco Sebastiani, Paolo Airò, Laura Bazzichi, Francesco Cristini, Valerio Del Bono, Andreina Manfredi, Ombretta Viapiana, Francesco De Rosa, Ennio Favalli, Enzo Petrelli, Carlo Salvarani, Marcello Govoni, Silvia Corcione, Rossana Scrivo, Loredana Sarmati, Adriano Lazzarin, Walter Grassi, Claudio Mastroianni, Giovanni Battista Gaeta, Gianfranco Ferraccioli, Maurizio Cutolo, Salvatore De Vita, Giovanni Lapadula, Marco Matucci-Cerinic, Orlando Armignacco, Piercarlo Sarzi-Puttini
• Journal: Clinical and experimental rheumatology (Clin Exp Rheumatol) 2017 Nov-Dec Vol. 35 Issue 6 Pg. 1018-1028 ISSN: 0392-856X [Print] Italy
• PMID: 29185961 (Publication Type: Journal Article, Review)

Chemical References

• Antirheumatic Agents

Topics

• Antirheumatic Agents (adverse effects)
• Arthritis, Rheumatoid (complications)
• Coccidioidomycosis (drug therapy)
• Cryptococcosis (drug therapy)
• Histoplasmosis (drug therapy)
• Humans
• Lung Diseases, Fungal (drug therapy)
• Pneumonia, Pneumocystis (drug therapy)
• Pulmonary Aspergillosis (drug therapy)