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Related Experiment Video

Updated: Jun 7, 2026

Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases

Microbiological Rapid On-Site Evaluation for Pulmonary Infectious Diseases

Published on: March 1, 2024

Pneumocystis prophylaxis in rheumatic disease.

Rachel M Wolfe¹, Kevin L Winthrop²

¹Wake Forest School of Medicine, Section on Rheumatology, Medical Center Blvd, Winston Salem, NC, 27104, USA.

Best Practice & Research. Clinical Rheumatology

|June 5, 2026

Summary

Pneumocystis jirovecii pneumonia (PJP) prophylaxis is crucial for rheumatic disease patients, yet guidelines vary. This review offers a risk-stratified approach to PJP prevention, improving clinical practice.

Keywords:

MDA5+ antibody PJP Pneumocystis prophylaxis Rheumatic disease

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Area of Science:

Rheumatology
Infectious Diseases
Pulmonology

Background:

Pneumocystis jirovecii pneumonia (PJP) is a severe opportunistic infection in rheumatic disease patients.
PJP mortality in rheumatic disease patients can exceed that in HIV-infected individuals.
Current clinical practice for PJP prophylaxis in rheumatic diseases lacks standardized, evidence-based guidelines.

Purpose of the Study:

To review PJP literature focusing on prophylaxis efficacy, adverse effects, and risk factors in rheumatic diseases.
To inform a pragmatic, risk-stratified approach to PJP prophylaxis for clinicians.
To address the variability in current clinical practice regarding PJP prophylaxis.

Main Methods:

Systematic review of existing PJP literature.
Analysis of prophylaxis efficacy, adverse events, and risk factors across various rheumatic conditions.
Development of a risk-stratification framework for PJP prophylaxis decisions.

Main Results:

Certain rheumatic conditions (e.g., ANCA-associated vasculitis, anti-MD5+ dermatomyositis, VEXAS syndrome) with high-dose glucocorticoid use warrant routine PJP prophylaxis.
Other conditions (e.g., Giant Cell Arteritis) may not require routine prophylaxis.
A practical framework for individualized PJP prophylaxis decisions was developed.

Conclusions:

A risk-stratified approach to PJP prophylaxis is essential for rheumatic disease patients.
Individualized prophylaxis decisions, guided by specific disease characteristics and treatment, are recommended.
This review provides a framework to optimize PJP prevention strategies in rheumatology.