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

Massimo Galli, Spinello Antinori, Fabiola Atzeni, Luca Meroni, Agostino Riva, Carlo A. 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 GovoniSilvia 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

Research output: Contribution to journalReview article

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 five 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).

Original languageEnglish
Pages (from-to)1018-1028
Number of pages11
JournalClinical and Experimental Rheumatology
Volume35
Issue number6
Publication statusPublished - Nov 1 2017

Keywords

  • Fungal infection
  • Pneumonia
  • Recommendations
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

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  • Cite this

    Galli, M., Antinori, S., Atzeni, F., Meroni, L., Riva, A., Scirè, C. A., Adorni, F., Quartuccio, L., Sebastiani, M., Airò, P., Bazzichi, L., Cristini, F., Del Bono, V., Manfredi, A., Viapiana, O., De Rosa, F., Favalli, E., Petrelli, E., Salvarani, C., ... Sarzi-Puttini, P. (2017). Recommendations for the management of pulmonary fungal infections in patients with rheumatoid arthritis. Clinical and Experimental Rheumatology, 35(6), 1018-1028.