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OBJECTIVES: This study aimed to assess the risk factors for Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA) and investigate the potential of salazosulfapyridine (SASP) as a prophylactic agent. METHODS: The present study analyzed data from the Japanese Diagnosis Procedure Combination database, which provides comprehensive inpatient data (including diagnoses, procedures, and medications) covering a large portion of the population. We identified patients with RA who developed PCP among 14 190 patients diagnosed with RA at admission with a treatment history. Patients with RA who were receiving therapeutic doses of drugs for PCP were defined as having PCP. A nested case-control analysis was performed to compare patients with RA and PCP with age- and sex-matched control patients with RA without PCP in a ratio of 1:20. RESULTS: The cohort comprised 132 patients with PCP and 2575 controls. The risk factors for PCP in RA were chronic obstructive pulmonary disease, methotrexate (MTX), biological/targeted synthetic DMARDs (b/tsDMARDs), and high-dose glucocorticoids. SASP may have a protective effect against PCP, particularly in patients with RA treated with MTX and/or b/tsDMARDs. CONCLUSION: The large sample size of the present study suggests that SASP may be associated with a reduced PCP risk in RA patients.
Sato et al. (Mon,) studied this question.