Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Positivity for Anti-RNP Antibody Is a Risk Factor for Adverse Effects by Trimethoprim-Sulphamethoxazole, a Prophylaxis Agent of P. jiroveci Pneumonia, in Patients with Collagen-Vasular Diseases.

Maezawa1,  Reika, Kurasawa2,  Kazuhiro, Arai2,  Satoko, Owada2,  Takayoshi, Fukuda2,  Takeshi

Clinical Immunology, Dokkyo Medical University, Mibu, Tochigi, Japan
Dokkyo Medical University, Mibu, Tochigi, Japan

Purpose:

Pneumocystis jiroveci pneumonia (PCP) is a serious complication in patients with immunosuppressive therapy for collagen-vascular diseases (CVD). For prophylaxis of PCP, Trimethoprim-sulphamethoxazole (TMP-STX) is widely used. TMP-STX prevents the development of PCP, but often caused adverse effects (AEs) such as leucopenia, fever, and rash. However, risk factors for AEs by TMP-STX in CVD patients are unknown and also clinical features of AEs remain to be clarified. The aim of this study is to identify risk factors for AEs of TMP-STX, and to clarify clinical features of the AEs in CVD patients with immunosuppressive therapy.

Methods:

We reviewed medical records of consecutive 541 patients who received TMP-STX as prophylaxis for PCP from 2003 to 2009 in our department. Subjects were 312 patients with CVD including 82 SLE, 60 myositis, 55 vasculitis, 26 SSc and 12 MCTD, and 229 patients with pulmonary diseases including 116 interstitial pneumonia and 56 lung cancer. These patients received corticosteroid (more than 30mg/day predonisolone) with/without immunosuppressants.

Results:

AEs by TMP-STX were observed in 30 out of 541 patients (5.5%). Incidence of the AEs in CVD was 7.1%, significantly higher than that in pulmonary diseases (3.5%). In CVD, patients with SLE, MCTD and adult Still's disease frequently developed the AEs (11%, 33% and 13%, respectively), compared to those with myositis and vasculitis(4% and 5%). Particularly, incidence of the AEs in patients with anti-RNP antibody were significantly higher than those without the antibody (a-RNP(+) vs. (-); 21% vs 7%). High incidence of the AEs in RNP positive patients was observed in SLE. In addition, incidence of the AEs in CVD patients without anti-RNP antibody was similar to that in pulmonary diseases. Incidence of the AEs were similar between patients with and without antibodies such as anti-DNA, anti-SS-A, and anti-Sm antibodies.

Clinical features of the AEs in patients with CVD were different from those with pulmonary diseases. Fever was most frequent symptom in AEs in patients with CVDs, while no fever was observed as AEs in those with pulmonary diseases.

Conclusion:

SLE and MCTD, and positively for anti-RNP antibody are risks factor for adverse effects by trimethoprim-sulphamethoxazole in collagen-vascular disease patients

To cite this abstract, please use the following information:
Maezawa, Reika, Kurasawa, Kazuhiro, Arai, Satoko, Owada, Takayoshi, Fukuda, Takeshi; Positivity for Anti-RNP Antibody Is a Risk Factor for Adverse Effects by Trimethoprim-Sulphamethoxazole, a Prophylaxis Agent of P. jiroveci Pneumonia, in Patients with Collagen-Vasular Diseases. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :472
DOI: 10.1002/art.28241

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