medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-20-138-143medsovet-2244Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYПНЕВМОЦИСТНАЯ ПНЕВМОНИЯ ПРИ РЕВМАТИЧЕСКИХ ЗАБОЛЕВАНИЯХ: ВОПРОСЫ ПРОФИЛАКТИКИPNEUMOCYSTIC PNEUMONIA IN RHEUMATIC DISEASES: CURRENT ISSUES IN PROPHYLAXISБеловБ. С.BelovB. S.

доктор медицинских наук.

Москва.

 MD.

Moscow.

ТарасоваГ. М.TarasovaG. M.

кандидат медицинских наук.

Москва. 

PhD in medicine.

Moscow.

БухановаД. С.BukhanovaD. S.

Москва.

Moscow.

Научно-исследовательский институт ревматологии им. В.А. Насоновой.РоссияNasonova Research Institute of Reumatology.Russian Federation201707012018020138143Copyright © Белов Б.С., Тарасова Г.М., Буханова Д.С., 20182018Белов Б.С., Тарасова Г.М., Буханова Д.С.Belov B.S., Tarasova G.M., Bukhanova D.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2244

В современных условиях иммуносупрессивная терапия системных ревматических заболеваний (РЗ) получает все большее распространение. В то же время активное применение иммуносупрессоров, в т. ч. генно-инженерных биологических препаратов, сопровождается нарастанием оппортунистических инфекций. К числу последних относится пневмоцистная пневмония (ППн), которая представляет собой серьезное осложнение со значимой летальностью у больных РЗ. Однако, учитывая неоднородные данные о рисках, касающихся конкретных РЗ и той или иной иммуносупрессивной терапии, создание основанного на доказательных принципах всеобъемлющего руководства по профилактике ППн в ревматологии в настоящее время не представляется возможным. Определенными ориентирами для практических врачей могут служить опубликованные разными авторскими коллективами алгоритмы профилактики ППн, которые, несомненно, подлежат дальнейшей доработке (или переработке) по мере накопления новых данных в рамках рассматриваемой проблемы.

In the current context, immunosuppressive therapy of systemic rheumatic diseases (RD) is becoming more widespread. At the same time, the active use of immunosuppressors including genetically engineered biological preparations is accompanied by an increase in opportunistic infections. The latter include pneumocystic pneumonia (PPn), which is a serious complication with significant mortality in patients with RD. However, given the heterogeneous data on the risks of specific RH and some or other immunosuppressive therapy, the development of a evidence-based comprehensive guide on the prevention of PPn in rheumatology is currently not possible. Specific guidelines for practical physicians can serve as algorithms of PPn prevention published by different authors, which are sure to be further followed-up (or processed) as new data are accumulated within the framework of the problem under consideration.

пневмоцистная пневмонияревматические заболеванияглюкокортикоидыцитостатикико-тримоксазолпрофилактикаpneumocystis pneumoniarheumatic diseasesglucocorticoidscytostaticsco-trimoxazoleprophylaxisReferencesПневмоцистоз – актуальная иммунодефицитассоциированная инфекция (эпидемиология, клиника, диагностика и лечение): Методи ческие рекомендации. М.: Федеральный центр гигиены и эпидемиологии Роспотребнадзора, 2010. 31 с.Пневмоцистоз – актуальная иммунодефицитассоциированная инфекция (эпидемиология, клиника, диагностика и лечение): Методи ческие рекомендации. М.: Федеральный центр гигиены и эпидемиологии Роспотребнадзора, 2010. 31 с.Centers for Disease Control and Prevention: Pneumoycstis pneumonia. Данные на сайте www.cdc.gov/fungal/diseases/pneumocystispneumonia (2014). Дата обращения: 4 сентября 2017 г.Centers for Disease Control and Prevention: Pneumoycstis pneumonia. Данные на сайте www.cdc.gov/fungal/diseases/pneumocystispneumonia (2014). Дата обращения: 4 сентября 2017 г.Ward MM, Donald F. Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality. Arthritis Rheum, 1999, 42(4): 780–9.Ward MM, Donald F. Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality. Arthritis Rheum, 1999, 42(4): 780–9.Cettomai D, Gelber AC, Christopher-Stine L. A survey of rheumatologists’ practice for prescri bing pneumocystis prophylaxis. J Rheumatol, 2010, 37(4): 792–9.Cettomai D, Gelber AC, Christopher-Stine L. A survey of rheumatologists’ practice for prescri bing pneumocystis prophylaxis. J Rheumatol, 2010, 37(4): 792–9.Gupta D, Zachariah A, Roppelt H, et al. Prophylactic antibiotic usage for pneumocystis jirovecii pneumonia in patients with systemic lupus erythematosus on cyclophosphamide: a survey of US rheumatologist and the review of literature. J Clin Rheumatol, 2008, 14: 267–72.Gupta D, Zachariah A, Roppelt H, et al. Prophylactic antibiotic usage for pneumocystis jirovecii pneumonia in patients with systemic lupus erythematosus on cyclophosphamide: a survey of US rheumatologist and the review of literature. J Clin Rheumatol, 2008, 14: 267–72.Green H, Paul M, Vidal L, Leibovici L. Prophyla xis of Pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc, 2007, 82(9): 1052-9.Green H, Paul M, Vidal L, Leibovici L. Prophyla xis of Pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and meta-analysis of randomized controlled trials. Mayo Clin Proc, 2007, 82(9): 1052-9.Мазус А.И., Каминский Г.Д., Зимина В.Н., и др. Национальные клинические рекомендации по диагностике и лечению ВИЧ-инфекции. 2-е изд., испр. доп. М., 2014, 75 с.Мазус А.И., Каминский Г.Д., Зимина В.Н., и др. Национальные клинические рекомендации по диагностике и лечению ВИЧ-инфекции. 2-е изд., испр. доп. М., 2014, 75 с.Sowden E, Carmichael AJ. Autoimmune inflammatory disorders, systemic corticosteroids and pneumocystis pneumonia: a strategy for prevention. BMC Infect Dis, 2004, 4: 42. doi: 10.1186/1471-2334-4-42.Sowden E, Carmichael AJ. Autoimmune inflammatory disorders, systemic corticosteroids and pneumocystis pneumonia: a strategy for prevention. BMC Infect Dis, 2004, 4: 42. doi: 10.1186/1471-2334-4-42.Li J, Huang XM, Fang WG, et al. Pneumocystis carinii pneumonia in patients with connective tissue disease. J Clin Rheumatol, 2006, 12(3): 114–7.Li J, Huang XM, Fang WG, et al. Pneumocystis carinii pneumonia in patients with connective tissue disease. J Clin Rheumatol, 2006, 12(3): 114–7.Marie I, Hachulla E, Cherin P, et al. Opportunistic infections in polymyositis and dermatomyositis. Arthritis Rheum, 2005, 53(2): 155–65.Marie I, Hachulla E, Cherin P, et al. Opportunistic infections in polymyositis and dermatomyositis. Arthritis Rheum, 2005, 53(2): 155–65.Kadoya A, Okada J, Iikuni Y, et al. Risk factors for pneumocystis carinii pneumonia in patients with polymyositis/dermatomyositis or systemic lupus erythematosus. J Rheumatol, 1996, 23(7): 1186–8.Kadoya A, Okada J, Iikuni Y, et al. Risk factors for pneumocystis carinii pneumonia in patients with polymyositis/dermatomyositis or systemic lupus erythematosus. J Rheumatol, 1996, 23(7): 1186–8.Chen M, Tian X, Qin F, et al. Pneumocystis pneumonia in patients with autoimmune disease: a retrospective study focused on clinical characteristics and prognostic factors related to death. PLoS One, 2015, 10(9): e0139144. doi: 10.1371/journal.pone.0139144.Chen M, Tian X, Qin F, et al. Pneumocystis pneumonia in patients with autoimmune disease: a retrospective study focused on clinical characteristics and prognostic factors related to death. PLoS One, 2015, 10(9): e0139144. doi: 10.1371/journal.pone.0139144.Teichtahl AJ, Morrisroe K, Ciciriello S, et al. Penumocystis jirovecci pneumonia in connective tissue diseases: comparison with other immunocompromised patients. Semin Arthritis Rheum, 2015, 45: 86–90.Teichtahl AJ, Morrisroe K, Ciciriello S, et al. Penumocystis jirovecci pneumonia in connective tissue diseases: comparison with other immunocompromised patients. Semin Arthritis Rheum, 2015, 45: 86–90.Godeau B, Mainardi JL, Roudot-Thoraval F, et al. Factors associated with pneumocystis carinii pneumonia in wegener’s granulmatosis. Ann Rheum Dis, 1995, 54: 991–4.Godeau B, Mainardi JL, Roudot-Thoraval F, et al. Factors associated with pneumocystis carinii pneumonia in wegener’s granulmatosis. Ann Rheum Dis, 1995, 54: 991–4.Ogawa J, Harigai M, Nagasaka K, et al. Prediction of and prophylaxis against pneumocystis pneumonia in patients with connective tissue diseases undergoing medium- or high-dose corticosteroid therapy. Mod Rheumatol, 2005, 15: 91–6.Ogawa J, Harigai M, Nagasaka K, et al. Prediction of and prophylaxis against pneumocystis pneumonia in patients with connective tissue diseases undergoing medium- or high-dose corticosteroid therapy. Mod Rheumatol, 2005, 15: 91–6.Porges AJ, Beattie SL, et al. Patients with systemic lupus erythematosus at risk for pneumocystis carinii pneumonia. J Rheumatol, 1992, 19: 1191–4.Porges AJ, Beattie SL, et al. Patients with systemic lupus erythematosus at risk for pneumocystis carinii pneumonia. J Rheumatol, 1992, 19: 1191–4.Mansharamani NG, Balachandran D, et al. Peripheral blood CD4 + T-lymphocyte counts during pneumocystis carinii pneumonia in immunocompromised patients without HIV infection. Chest, 2000, 118(3): 712–20.Mansharamani NG, Balachandran D, et al. Peripheral blood CD4 + T-lymphocyte counts during pneumocystis carinii pneumonia in immunocompromised patients without HIV infection. Chest, 2000, 118(3): 712–20.Falagas ME, Manta KG, Betsi GI, et al. Infectionrelated morbidity and mortality in patients with connective tissue diseases: a systemic review. Clin Rheumatol, 2007, 26: 663–70.Falagas ME, Manta KG, Betsi GI, et al. Infectionrelated morbidity and mortality in patients with connective tissue diseases: a systemic review. Clin Rheumatol, 2007, 26: 663–70.Okada J, Kadoya A, Rana M, et al. Efficacy of sulfamethoxazoletrimthoprim administration in the prevention of pneumocystis carinii pneumonia in patients with connective tissue disease. Kansenshogaku Zasshi, 1999, 73(11): 1123–9.Okada J, Kadoya A, Rana M, et al. Efficacy of sulfamethoxazoletrimthoprim administration in the prevention of pneumocystis carinii pneumonia in patients with connective tissue disease. Kansenshogaku Zasshi, 1999, 73(11): 1123–9.Mecoli CA, Saylor D, Gelber AC, et al. Pneumocystis jiroveci pneumonia in rheumatic disease: a 20-year single-centre experience. Clin Exp Rheumatol, 2017, 35(4): 671-673.Mecoli CA, Saylor D, Gelber AC, et al. Pneumocystis jiroveci pneumonia in rheumatic disease: a 20-year single-centre experience. Clin Exp Rheumatol, 2017, 35(4): 671-673.Park JW, Curtis JR, Moon J, et al. Prophylactic effect of trimethoprim-sulfamethoxazole for pneumocystis pneumonia in patients with rheumatic diseases exposed to prolonged high-dose glucocorticoids. Ann Rheum Dis, 2017, published online November 1.Park JW, Curtis JR, Moon J, et al. Prophylactic effect of trimethoprim-sulfamethoxazole for pneumocystis pneumonia in patients with rheumatic diseases exposed to prolonged high-dose glucocorticoids. Ann Rheum Dis, 2017, published online November 1.Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc, 1996, 71(1): 5–13.Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc, 1996, 71(1): 5–13.Kermani TA, Ytterberg SR, Warrington KJ. Pneumocystis jiroveci pneumonia in giant cell arteritis: a case series. Arthritis Care Res, 2011, 63(5): 761–5.Kermani TA, Ytterberg SR, Warrington KJ. Pneumocystis jiroveci pneumonia in giant cell arteritis: a case series. Arthritis Care Res, 2011, 63(5): 761–5.Guillevin L, Cordier JF, Lhote F, et al. A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized wegener’s granulomatosis. Arthritis Rheum, 1997, 40(12): 2187–98.Guillevin L, Cordier JF, Lhote F, et al. A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized wegener’s granulomatosis. Arthritis Rheum, 1997, 40(12): 2187–98.Demoruelle MK, Kahr A, Verilhac K, et al. Recent-onset systemic lupus erythematosus complicated by acute respiratory failure. Arthritis Care Res, 2013, 65(2): 314–23.Demoruelle MK, Kahr A, Verilhac K, et al. Recent-onset systemic lupus erythematosus complicated by acute respiratory failure. Arthritis Care Res, 2013, 65(2): 314–23.Kaur N, Mahl TC. Pneumocystis jiroveci (carinii) pneumonia after infliximab therapy: a review of 84 cases. Dig Dis Sci, 2007 Jun, 52(6): 1481-4.Kaur N, Mahl TC. Pneumocystis jiroveci (carinii) pneumonia after infliximab therapy: a review of 84 cases. Dig Dis Sci, 2007 Jun, 52(6): 1481-4.Teichmann LL, Woenckhaus M, Vogel C, et al. Fatal Pneumocystis pneumonia following rituximab administration for rheumatoid arthritis. Rheumatology, 2008, 47(8): 1256-7.Teichmann LL, Woenckhaus M, Vogel C, et al. Fatal Pneumocystis pneumonia following rituximab administration for rheumatoid arthritis. Rheumatology, 2008, 47(8): 1256-7.Wolfe RM, Peacock JE. Pneumocystis Pneumonia and the Rheumatologist: Which Patients Are At Risk and How Can PCP Be Prevented? Curr Rheumatol Rep, 2017, 19(6): 35. doi: 10.1007/s11926-017-0664-6.Wolfe RM, Peacock JE. Pneumocystis Pneumonia and the Rheumatologist: Which Patients Are At Risk and How Can PCP Be Prevented? Curr Rheumatol Rep, 2017, 19(6): 35. doi: 10.1007/s11926-017-0664-6.Ognibene FP, Shelhamer JH, Hoffman GS, et al. Pneumocystis carinii pneumonia: a major complication of immunosuppressive therapy in patients with wegener’s granulomatosis. Am J Respir Crit Care Med, 1995, 151: 795–9.Ognibene FP, Shelhamer JH, Hoffman GS, et al. Pneumocystis carinii pneumonia: a major complication of immunosuppressive therapy in patients with wegener’s granulomatosis. Am J Respir Crit Care Med, 1995, 151: 795–9.Godeau B, Coutant-Perronne V, Huong DLT, et al. Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases. J Rheumatol, 1994, 21(2): 246–51.Godeau B, Coutant-Perronne V, Huong DLT, et al. Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases. J Rheumatol, 1994, 21(2): 246–51.Vananuvat P,Suwannalai P,Sungkanuparph S, et al. Primary prophylaxis for pneumocystis jiro vecii pneumonia in patients with connective tissue diseases. Semin Arthritis Rheum, 2011, 41: 497–502.Vananuvat P,Suwannalai P,Sungkanuparph S, et al. Primary prophylaxis for pneumocystis jiro vecii pneumonia in patients with connective tissue diseases. Semin Arthritis Rheum, 2011, 41: 497–502.Zycinska K, Wardyn KA, Zielonka TM, et al. Co-trimoxazole and prevention of relapses of PR3-ANCA positive vasculitis with pulmonary involvement. Eur J Med Res, 2009, 14: 265–7.Zycinska K, Wardyn KA, Zielonka TM, et al. Co-trimoxazole and prevention of relapses of PR3-ANCA positive vasculitis with pulmonary involvement. Eur J Med Res, 2009, 14: 265–7.Bourre-Tessier J, Haraoui B. Methotrexate drug interactions in the treatment of rheumatoid arthritis: a systematic review. J Rheumatol, 2010, 37(7): 1416–21.Bourre-Tessier J, Haraoui B. Methotrexate drug interactions in the treatment of rheumatoid arthritis: a systematic review. J Rheumatol, 2010, 37(7): 1416–21.Fillatre P, Decaux O, Jouneau S. et al. Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients. Am J Med, 2014, 127(12): 1242.e11-7.Fillatre P, Decaux O, Jouneau S. et al. Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients. Am J Med, 2014, 127(12): 1242.e11-7.Zhang Y, Zheng Y. Pneumocystis jirovecii pneumonia in mycophenolate mofetil-treated patients with connective tissue disease: analysis of 17 cases. Rheumatol Int, 2014, 34: 1765–71.Zhang Y, Zheng Y. Pneumocystis jirovecii pneumonia in mycophenolate mofetil-treated patients with connective tissue disease: analysis of 17 cases. Rheumatol Int, 2014, 34: 1765–71.Jones RB, Tervaert JWC, Hauser T, et al. Rituxi mab versus cyclophosphamide in ANCA-associ ated renal vasculitis. N Engl J Med, 2010, 363: 211–20.Jones RB, Tervaert JWC, Hauser T, et al. Rituxi mab versus cyclophosphamide in ANCA-associ ated renal vasculitis. N Engl J Med, 2010, 363: 211–20.Specks U, Merkel PA, Seo P, et al. Efficacy of remission-induction regimens for ANCA-associated vasculitis. N Engl J Med, 2013, 369(5): 417–27.Specks U, Merkel PA, Seo P, et al. Efficacy of remission-induction regimens for ANCA-associated vasculitis. N Engl J Med, 2013, 369(5): 417–27.Guillevin L, Pagnoux C, Karras A, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med, 2014, 371(19): 1771–80.Guillevin L, Pagnoux C, Karras A, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med, 2014, 371(19): 1771–80.Kronbichler A, Jayne DRW, Mayer G. Frequency, risk factors and prophylaxis of infection in ANCA-associated vasculitis. Eur J Clin Investig, 2015, 45(3): 346–68.Kronbichler A, Jayne DRW, Mayer G. Frequency, risk factors and prophylaxis of infection in ANCA-associated vasculitis. Eur J Clin Investig, 2015, 45(3): 346–68.Yates M, Watts RA, Bajema IM, et al. EULAR/ ERA-EDTA recommendations for themanagement of ANCA-associated vasculitis. Ann Rheum Dis, 2016, 75: 1583–94.Yates M, Watts RA, Bajema IM, et al. EULAR/ ERA-EDTA recommendations for themanagement of ANCA-associated vasculitis. Ann Rheum Dis, 2016, 75: 1583–94.Chung JB, Armstrong K, Schwartz S, et al. Costeffectiveness of prophylaxis against pneumocystis carinii pneumonia in patients with wegener’s granulomatosis undergoing immunosuppressive therapy. Arthritis Rheum, 2000, 43(8): 1841–8.Chung JB, Armstrong K, Schwartz S, et al. Costeffectiveness of prophylaxis against pneumocystis carinii pneumonia in patients with wegener’s granulomatosis undergoing immunosuppressive therapy. Arthritis Rheum, 2000, 43(8): 1841–8.Petri M, Allbritton J. Antibiotic allergy in systemic lupus erythematosus: a case-control study. J Rheumatol, 1992, 19(2): 265–9.Petri M, Allbritton J. Antibiotic allergy in systemic lupus erythematosus: a case-control study. J Rheumatol, 1992, 19(2): 265–9.Pope J, Jerome D, Fenlon D, et al. Frequency of adverse drug reactions in patients with systemic lupus erythematosus. J Rheumatol, 2003, 30: 480–4.Pope J, Jerome D, Fenlon D, et al. Frequency of adverse drug reactions in patients with systemic lupus erythematosus. J Rheumatol, 2003, 30: 480–4.Maezawa R, Kurasawa K, Arai S, et al. Positivity for anti-RNP antibody is a risk factor for adverse effects caused by trimethoprim-sulfamethoxazole, a prophylactic agent for P. jiroveci pneumonia, in patients with connective tissue diseases. Mod Rheumatol, 2013, 23: 62–70.Maezawa R, Kurasawa K, Arai S, et al. Positivity for anti-RNP antibody is a risk factor for adverse effects caused by trimethoprim-sulfamethoxazole, a prophylactic agent for P. jiroveci pneumonia, in patients with connective tissue diseases. Mod Rheumatol, 2013, 23: 62–70.Grubbs JA, Baddley JW. Pneumocystis jirovecii pneumonia in patients receiving tumor-necrosis-factor-inhibitor therapy: implications for chemoprophylaxis. Curr Rheumatol Rep, 2014, 16(10): 445. doi: 10.1007/s11926-014-0445-4.Grubbs JA, Baddley JW. Pneumocystis jirovecii pneumonia in patients receiving tumor-necrosis-factor-inhibitor therapy: implications for chemoprophylaxis. Curr Rheumatol Rep, 2014, 16(10): 445. doi: 10.1007/s11926-014-0445-4.Lichtenstein GR, Feagan BG, Cohen RD et al. Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT™ registry. Am J Gastroenterol, 2012, 107(9): 1409-22.Lichtenstein GR, Feagan BG, Cohen RD et al. Serious infection and mortality in patients with Crohn’s disease: more than 5 years of follow-up in the TREAT™ registry. Am J Gastroenterol, 2012, 107(9): 1409-22.Baddley JW, Winthrop KL, Chen L. et al. Nonviral opportunistic infections in new users of tumour necrosis factor inhibitor therapy: results of the SAfety Assessment of Biologic ThERapy (SABER) study. Ann Rheum Dis, 2014 Nov, 73(11): 1942-8.Baddley JW, Winthrop KL, Chen L. et al. Nonviral opportunistic infections in new users of tumour necrosis factor inhibitor therapy: results of the SAfety Assessment of Biologic ThERapy (SABER) study. Ann Rheum Dis, 2014 Nov, 73(11): 1942-8.Dixon WG, Watson K, Lunt M. et al. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum, 2006, 54(8): 2368-76.Dixon WG, Watson K, Lunt M. et al. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum, 2006, 54(8): 2368-76.Greenberg JD, Reed G, Kremer JM, et al. Associ ation of methotrexate and tumour necrosis factor antagonists with risk of infectious outcomes including opportunistic infections in the CORRONA registry. Ann Rheum Dis, 2010 Feb, 69(2): 380-6.Greenberg JD, Reed G, Kremer JM, et al. Associ ation of methotrexate and tumour necrosis factor antagonists with risk of infectious outcomes including opportunistic infections in the CORRONA registry. Ann Rheum Dis, 2010 Feb, 69(2): 380-6.Salmon-Ceron D, Tubach F, Lortholary O. et al. Drug-specific risk of non-tuberculosis opportunistic infections in patients receiving anti-TNF therapy reported to the 3-year prospective French RATIO registry. Ann Rheum Dis, 2011, 70(4): 616-23.Salmon-Ceron D, Tubach F, Lortholary O. et al. Drug-specific risk of non-tuberculosis opportunistic infections in patients receiving anti-TNF therapy reported to the 3-year prospective French RATIO registry. Ann Rheum Dis, 2011, 70(4): 616-23.Takeuchi T, Tatsuki Y, Nogami Y et al. Post marketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis. Ann Rheum Dis, 2008, 67(2): 189-94.Takeuchi T, Tatsuki Y, Nogami Y et al. Post marketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis. Ann Rheum Dis, 2008, 67(2): 189-94.Koike T, Harigai M, Inokuma S. et al. Postmarke ting surveillance of the safety and effectiveness of etaner cept in Japan. J Rheumatol, 2009, 36(5): 898-906.Koike T, Harigai M, Inokuma S. et al. Postmarke ting surveillance of the safety and effectiveness of etaner cept in Japan. J Rheumatol, 2009, 36(5): 898-906.Komano Y, Tanaka M, Nanki T, et al. Incidence and risk factors for serious infection in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors: a report from the Registry of Japanese Rheumatoid Arthritis Patients for Longterm Safety. J Rheumatol, 2011, 38(7): 1258-64.Komano Y, Tanaka M, Nanki T, et al. Incidence and risk factors for serious infection in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors: a report from the Registry of Japanese Rheumatoid Arthritis Patients for Longterm Safety. J Rheumatol, 2011, 38(7): 1258-64.Beukelman T, Xie F, Baddley JW et al. Brief report: incidence of selected opportunistic infections among children with juvenile idiopathic arthritis. Arthritis Rheum, 2013, 65(5): 1384-9.Beukelman T, Xie F, Baddley JW et al. Brief report: incidence of selected opportunistic infections among children with juvenile idiopathic arthritis. Arthritis Rheum, 2013, 65(5): 1384-9.Mori S, Sugimoto M. Pneumocystis jirovecii Pneumo nia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations. Clin Med Insights Circ Respir Pulm Med, 2015, 9(Suppl 1): 29-40.Mori S, Sugimoto M. Pneumocystis jirovecii Pneumo nia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations. Clin Med Insights Circ Respir Pulm Med, 2015, 9(Suppl 1): 29-40.Louie GH, Wang Z, Ward MM. Trends in hospitalizations for Pneumocystis jiroveci pneumonia among patients with rheumatoid arthritis in the US: 1996-2007. Arthritis Rheum, 2010, 62(12): 3826-7.Louie GH, Wang Z, Ward MM. Trends in hospitalizations for Pneumocystis jiroveci pneumonia among patients with rheumatoid arthritis in the US: 1996-2007. Arthritis Rheum, 2010, 62(12): 3826-7.Kourbeti IS, Ziakas PD, Mylonakis E. Biologic therapies in rheumatoid arthritis and the risk of opportunistic infections: a meta-analysis. Clin Infect Dis, 2014, 58(12): 1649-57.Kourbeti IS, Ziakas PD, Mylonakis E. Biologic therapies in rheumatoid arthritis and the risk of opportunistic infections: a meta-analysis. Clin Infect Dis, 2014, 58(12): 1649-57.Foocharoen C, Siriphannon Y, Mahakkanukrauh A.et al. Incidence rate and causes of infection in Thai systemic sclerosis patients. Int J Rheum Dis, 2012, 15(3): 277-83.Foocharoen C, Siriphannon Y, Mahakkanukrauh A.et al. Incidence rate and causes of infection in Thai systemic sclerosis patients. Int J Rheum Dis, 2012, 15(3): 277-83.Tashkin DP, Elashoff R, Clements PJ, et al. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med, 2006, 354(25): 2655-66.Tashkin DP, Elashoff R, Clements PJ, et al. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med, 2006, 354(25): 2655-66.

The authors declare that there are no conflicts of interest present.