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Int J Rheum Dis. 2019 Apr;22(4):583-591. doi: 10.1111/1756-185X.13467. Epub 2019 Feb 10.

Pulse corticosteroids in treatment of rheumatic disease concomitant with cytomegalovirus infection.

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Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Peking-Tsinghua Center for Life Sciences, Beijing, China.
Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.



To investigate the impact of corticosteroids on the outcome of antiviral therapy in rheumatic patients with cytomegalovirus (CMV)-emia.


Sixty-two patients with rheumatic disease complicated by CMV infection from 2011 to 2014 were retrospectively analyzed.


Fifty-five of 62 patients were diagnosed with CMV-DNAemia. Most patients (43/55, 78.2%) achieved viral clearance within 5 weeks. It was shown that, while undergoing active antiviral therapy, there was no significant difference in the CMV-DNAemia clearance rate between the pulse methylprednisolone (MPSL) therapy group and non-pulse group (8/9, 88.9% vs 30/36, 83.3%; OR = 1.600, 95% CI 0.168-15.273, P > 0.05) at the end of the 5-week follow-up. However, pulse MPSL might slightly prolong duration of CMV-DNAemia than non-pulse MPSL patients (20.78 ± 19.18 days vs 14.33 ± 9.01 days, P = 0.1430), especially in the high baseline titer group (33.7 ± 29.1 days in pulse MPSL group vs 18.3 ± 13.1 days in non-pulse group, P = 0.457). But in the low baseline titer group, CMVemia duration in the pulse MPSL group (14.3 ± 10.0 days) was about the same as that in the non-pulse MPSL group (13.4 ± 7.8 days).


With effective antiviral therapy, pulse MPSL is acceptable in rheumatic disease patients with CMV-DNAemia, without significant impact on final clearance of virus. However, duration of CMV-DNAemia may be prolonged, especially in patients with high CMV-DNA titer at baseline.


corticosteroids; cytomegalovirus; rheumatic disease; viral clearance


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