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Research article
Sheng Chen
Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2617-0967
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Idiopathic inflammatory myopathies (IIM) was associated with a significantly higher risk of opportunistic infections that including Pneumocystis jiroveci pneumonia (PJP), a potentially fatal opportunistic infection. However, no prior studies have evaluated the PJP infection in subtypes of IIM.
Objectives
To investigate the incidence rate and mortality rate of PJP infection in subgroups of Idiopathic inflammatory myopathies (IIM) patients according to myopathy specific antibodies.
Methods
In the first part, 463 consecutive patients with IIM were prospectively followed up for a period of at least one year to analyze incidence of PJP. In the next part, we enrolled 30 consecutive PJP patients with any rheumatic disease were to identify the mortality rate and risk factors by Cox regression. Kaplan-Meier curve with log-rank test was used to access differences in survival.
Results
We found that the incidence rate of PJP in IIM patients is 3.0/100 person-year, while in MDA5+DM patients is 7.5/100 person-year and in MDA5−IIM patients is 0.7/100 person-year. (P < 0.05). PJP typically happened in the first two months for MDA5 + DM patients who have a significant decrease in the CD4+ T cell counts and Lymphocyte counts (P < 0.05). In PJP + patients, the mortality was lethally higher in MDA5+DM patients than those with other rheumatic diseases (83.3% VS. 38.9%, P < 0.05). Unlike patients with other rheumatic diseases, MDA5 + patients seemed not to benefit from prompt anti-PJP treatment. For patients with other rheumatic diseases, anti-PJP treatment within 6 days was confirmed to crucially increased the survival (P < 0.05).
Conclusion
PJP has alarming high incidence and mortality in MDA5+DM patients. Timely treatment for PJP does not improve the prognosis of this particular subtype. Therefore, the necessity of further study of PJP prophylaxis treatment in MDA5+DM patients is verified.
Keywords
anti-MDA5-antibody-positve dermatomyositis, Pneumocystis jiroveci pneumonia, incidence, mortality, treatment
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CURRENT STATUS: Under Review
Version 1
Posted 30 Mar, 2021
No community comments so far
Editorial decision: Major revision
On 18 May, 2021
Review #1 received
Received 17 Apr, 2021
Review #2 received
Received 17 Apr, 2021
Reviewer #3 agreed
On 04 Apr, 2021
Reviewer #2 agreed
On 02 Apr, 2021
Reviews received
Received 02 Apr, 2021
Reviewer #1 agreed
On 02 Apr, 2021
Reviewers invited
Invitations sent on 01 Apr, 2021
Editor assigned
On 21 Mar, 2021
Submission checks complete
On 21 Mar, 2021
Editor invited
On 21 Mar, 2021
First submitted
On 18 Mar, 2021
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Subject Areas
Rheumatology
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This preprint is under consideration at Arthritis Research & Therapy. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Sheng Chen
Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2617-0967
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 30 Mar, 2021
No community comments so far
Editorial decision: Major revision
On 18 May, 2021
Review #1 received
Received 17 Apr, 2021
Review #2 received
Received 17 Apr, 2021
Reviewer #3 agreed
On 04 Apr, 2021
Reviewer #2 agreed
On 02 Apr, 2021
Reviews received
Received 02 Apr, 2021
Reviewer #1 agreed
On 02 Apr, 2021
Reviewers invited
Invitations sent on 01 Apr, 2021
Editor assigned
On 21 Mar, 2021
Submission checks complete
On 21 Mar, 2021
Editor invited
On 21 Mar, 2021
First submitted
On 18 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Rheumatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Idiopathic inflammatory myopathies (IIM) was associated with a significantly higher risk of opportunistic infections that including Pneumocystis jiroveci pneumonia (PJP), a potentially fatal opportunistic infection. However, no prior studies have evaluated the PJP infection in subtypes of IIM.
Objectives
To investigate the incidence rate and mortality rate of PJP infection in subgroups of Idiopathic inflammatory myopathies (IIM) patients according to myopathy specific antibodies.
Methods
In the first part, 463 consecutive patients with IIM were prospectively followed up for a period of at least one year to analyze incidence of PJP. In the next part, we enrolled 30 consecutive PJP patients with any rheumatic disease were to identify the mortality rate and risk factors by Cox regression. Kaplan-Meier curve with log-rank test was used to access differences in survival.
Results
We found that the incidence rate of PJP in IIM patients is 3.0/100 person-year, while in MDA5+DM patients is 7.5/100 person-year and in MDA5−IIM patients is 0.7/100 person-year. (P < 0.05). PJP typically happened in the first two months for MDA5 + DM patients who have a significant decrease in the CD4+ T cell counts and Lymphocyte counts (P < 0.05). In PJP + patients, the mortality was lethally higher in MDA5+DM patients than those with other rheumatic diseases (83.3% VS. 38.9%, P < 0.05). Unlike patients with other rheumatic diseases, MDA5 + patients seemed not to benefit from prompt anti-PJP treatment. For patients with other rheumatic diseases, anti-PJP treatment within 6 days was confirmed to crucially increased the survival (P < 0.05).
Conclusion
PJP has alarming high incidence and mortality in MDA5+DM patients. Timely treatment for PJP does not improve the prognosis of this particular subtype. Therefore, the necessity of further study of PJP prophylaxis treatment in MDA5+DM patients is verified.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
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