#4-90E. Stratifying the Risk: A Targeted Approach to PJP Prophylaxis in Rheumatology (BPRCR, 2026)

Do you ever struggle with deciding when to initiate PJP prophylaxis for your rheumatology patients on high-dose steroids? In this episode, we explore "Pneumocystis prophylaxis in rheumatic disease," a comprehensive review that examines the efficacy, adverse effects, and disease-specific risk factors of PJP prophylaxis across various rheumatic conditions. The authors provide a practical, risk-stratified framework to guide these complex clinical decisions. The most crucial takeaway is the proposed algorithm, which strongly recommends routine prophylaxis for high-risk conditions like ANCA-associated vasculitis during induction therapy, anti-MDA5+ dermatomyositis, and VEXAS syndrome, while advising against universal prophylaxis for diseases like giant cell arteritis. However, when critically appraising this paper, clinicians must keep in mind that the majority of the underlying evidence relies heavily on retrospective studies, which may introduce inherent biases. For prescribing physicians, this targeted approach is incredibly valuable; it helps prevent both dangerous opportunistic infections and unnecessary medication toxicities by avoiding a 'one-size-fits-all' prophylactic strategy, directly optimizing daily patient care.

Citation: Wolfe RM, Winthrop KL. Pneumocystis prophylaxis in rheumatic disease. Best Practice & Research Clinical Rheumatology. 2026. DOI: 10.1016/j.berh.2026.102164

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.