How do you approach PJP prophylaxis in patients with rheumatic disease on corticosteroids?   

Here is a graphic I made covering PJP Prophylaxis with Dr. @Cassie Calabrese if anyone is interested!   As noted, one can check absolute lymphocyte count (ALC) or CD4 count as factors to further risk stratify as well.

The guidelines for the need for PJP prophylaxis are generally based on the dose of corticosteroids alone (>20 mg prednisolone or equivalent qd for >4 weeks) or steroids in combination with other agents such as azathioprine, cyclophosphamide, or methotrexate. The presence of underlying ILD...

@Walter W. Chatham: Thanks so much for the Tang article. This is my first time seeing it. Question for you: Why do you choose an absolute lymphocyte count (ALC) less than 400? In Figure 3 of the article, only 2-3 of the patients appear to have an ALC of 200 or higher. If so, I just wonder if a level...

I tend to look at the total lymphocyte count - if it is <400/mm³ or embarking on an immunosuppression regimen very likely to effect that (which the guidelines alluded to by Dr. @Smulian are somewhat predictive of) I will initiate PJP prophylaxis. See: Tang et al., PMID 33912176