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Akuter Schub der Grunderkrankung oder Infektion

Welche Diagnostik ist bei Patienten mit entzündlich rheumatischen Erkrankungen unter immunsuppressiver Therapie sinnvoll?
  • Boris EhrensteinEmail author
Leitthema
  • 38 Downloads

Zusammenfassung

In der Differenzialdiagnose bei neuen Symptomen bei einer bereits vorbekannten und immunsuppressiv behandelten entzündlich rheumatischen Erkrankung müssen immer auch infektiöse Erkrankungen erwogen werden. Kenntnisse über die spezifische Häufigkeit und Art von Infektionen, die unter der immunsuppressiven Therapie von entzündlich rheumatischen Erkrankungen zu erwarten sind, sowie die Aussagekraft von Labordiagnostik und Bildgebung können die hier oft schwierige Differenzialdiagnose erleichtern.

Schlüsselwörter

Opportunistische Infektionen Immunsuppression Differenzialdiagnose Labordiagnostik Bildgebung 

Acute exacerbation of the underlying disease or infection

Which diagnostics are warranted in patients with immunosuppressive treatment for inflammatory rheumatic diseases?

Abstract

Infectious diseases always have to be considered in the differential diagnosis of new symptoms in patients with immunosuppressive treatment for established inflammatory rheumatic diseases. Knowledge about the specific frequency and type of infections that can be expected under immunosuppressive treatment of inflammatory rheumatic diseases as well as the diagnostic value of laboratory tests and imaging results can facilitate the often difficult differential diagnosis.

Keywords

Opportunistic infections Immunosuppression Differential diagnosis Laboratory diagnostic tests Imaging 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

B. Ehrenstein gibt an, dass bezüglich der Thematik des aktuellen Manuskripts keine Interessenkonflikte bestehen.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Baddley JW, Winthrop KL, Chen L et al (2014) Non-viral opportunistic infections in new users of tumour necrosis factor inhibitor therapy: results of the SAfety Assessment of Biologic ThERapy (SABER) study. Ann Rheum Dis 73:1942–1948CrossRefGoogle Scholar
  2. 2.
    Broca-Garcia BE, Saavedra MA, Martinez-Bencomo MA et al (2019) Utility of neutrophil-to-lymphocyte ratio plus C‑reactive protein for infection in systemic lupus erythematosus. Lupus 28:217–222CrossRefGoogle Scholar
  3. 3.
    Burmester GR, Landewe R, Genovese MC et al (2017) Adalimumab long-term safety: infections, vaccination response and pregnancy outcomes in patients with rheumatoid arthritis. Ann Rheum Dis 76:414–417CrossRefGoogle Scholar
  4. 4.
    Calderon-Goercke M, Loricera J, Aldasoro V et al (2019) Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum 49:126–135CrossRefGoogle Scholar
  5. 5.
    Chen DY, Chen YM, Ho WL et al (2009) Diagnostic value of procalcitonin for differentiation between bacterial infection and non-infectious inflammation in febrile patients with active adult-onset Still’s disease. Ann Rheum Dis 68:1074–1075CrossRefGoogle Scholar
  6. 6.
    Choi ST, Song JS (2016) Serum procalcitonin as a useful serologic marker for differential diagnosis between acute gouty attack and bacterial infection. Yonsei Med J 57:1139–1144CrossRefGoogle Scholar
  7. 7.
    Christensen KL, Holman RC, Steiner CA et al (2009) Infectious disease hospitalizations in the United States. Clin Infect Dis 49:1025–1035CrossRefGoogle Scholar
  8. 8.
    De Jager CP, Van Wijk PT, Mathoera RB et al (2010) Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care 14:R192CrossRefGoogle Scholar
  9. 9.
    Dixon WG, Abrahamowicz M, Beauchamp ME et al (2012) Immediate and delayed impact of oral glucocorticoid therapy on risk of serious infection in older patients with rheumatoid arthritis: a nested case-control analysis. Ann Rheum Dis 71:1128–1133CrossRefGoogle Scholar
  10. 10.
    Echeverri A, Naranjo-Escobar J, Posso-Osorio I et al (2018) Neutrophil CD64 expression, procalcitonin and presepsin are useful to differentiate infections from flares in SLE patients with SIRS. Lupus 27:1130–1139CrossRefGoogle Scholar
  11. 11.
    Feldman CH, Hiraki LT, Winkelmayer WC et al (2015) Serious infections among adult Medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis. Arthritis Rheumatol 67:1577–1585CrossRefGoogle Scholar
  12. 12.
    Forget P, Khalifa C, Defour JP et al (2017) What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes 10:12CrossRefGoogle Scholar
  13. 13.
    Fouque-Aubert A, Jette-Paulin L, Combescure C et al (2010) Serious infections in patients with ankylosing spondylitis with and without TNF blockers: a systematic review and meta-analysis of randomised placebo-controlled trials. Ann Rheum Dis 69:1756–1761CrossRefGoogle Scholar
  14. 14.
    Ginzler EM, Wallace DJ, Merrill JT et al (2014) Disease control and safety of belimumab plus standard therapy over 7 years in patients with systemic lupus erythematosus. J Rheumatol 41:300–309CrossRefGoogle Scholar
  15. 15.
    Harrold LR, Litman HJ, Saunders KC et al (2018) One-year risk of serious infection in patients treated with certolizumab pegol as compared with other TNF inhibitors in a real-world setting: data from a national U.S. rheumatoid arthritis registry. Arthritis Res Ther 20:2CrossRefGoogle Scholar
  16. 16.
    Herrmann K, Schinke S, Csernok E et al (2015) Diagnostic Value of Procalcitonin in ANCA-Associated Vasculitis (AAV) to Differentiate Between Disease Activity, Infection and Drug Hypersensitivity. Open Rheumatol J 9:71–76CrossRefGoogle Scholar
  17. 17.
    Kolditz M, Tesch F, Mocke L et al (2016) Burden and risk factors of ambulatory or hospitalized CAP: A population based cohort study. Respir Med 121:32–38CrossRefGoogle Scholar
  18. 18.
    Listing J, Strangfeld A, Kary S et al (2005) Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum 52:3403–3412CrossRefGoogle Scholar
  19. 19.
    Md Yusof MY, Vital EM, Mcelvenny DM et al (2019) Predicting severe infection and effects of hypogammaglobulinaemia during therapy with rituximab in rheumatic and musculoskeletal diseases. Arthritis Rheumatol.  https://doi.org/10.1002/art.40937 Google Scholar
  20. 20.
    Montastruc F, Renoux C, Hudson M et al (2019) Abatacept initiation in rheumatoid arthritis and the risk of serious infection: A population-based cohort study. Semin Arthritis Rheum 48:1053–1058CrossRefGoogle Scholar
  21. 21.
    Mori S, Yoshitama T, Hidaka T et al (2017) Comparative risk of hospitalized infection between biological agents in rheumatoid arthritis patients: a multicenter retrospective cohort study in Japan. PLoS ONE 12:e179179CrossRefGoogle Scholar
  22. 22.
    Pawar A, Desai RJ, Solomon DH et al (2019) Risk of serious infections in tocilizumab versus other biologic drugs in patients with rheumatoid arthritis: a multidatabase cohort study. Ann Rheum Dis 78:456–464CrossRefGoogle Scholar
  23. 23.
    Pryor BD, Bologna SG, Kahl LE (1996) Risk factors for serious infection during treatment with cyclophosphamide and high-dose corticosteroids for systemic lupus erythematosus. Arthritis Rheum 39:1475–1482CrossRefGoogle Scholar
  24. 24.
    Pyo JY, Ha YJ, Song JJ et al (2017) Delta neutrophil index contributes to the differential diagnosis between acute gout attack and cellulitis within 24 hours after hospitalization. Rheumatology 56:795–801Google Scholar
  25. 25.
    Schneeweiss S, Setoguchi S, Weinblatt ME et al (2007) Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Arthritis Rheum 56:1754–1764CrossRefGoogle Scholar
  26. 26.
    Schuetz P, Christ-Crain M, Thomann R et al (2009) Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA 302:1059–1066CrossRefGoogle Scholar
  27. 27.
    Seigel TA, Cocchi MN, Salciccioli J et al (2012) Inadequacy of temperature and white blood cell count in predicting bacteremia in patients with suspected infection. J Emerg Med 42:254–259CrossRefGoogle Scholar
  28. 28.
    Shi Y, Peng JM, Hu XY et al (2015) The utility of initial procalcitonin and procalcitonin clearance for prediction of bacterial infection and outcome in critically ill patients with autoimmune diseases: a prospective observational study. BMC Anesthesiol 15:137CrossRefGoogle Scholar
  29. 29.
    Shoenfeld Y, Gurewich Y, Gallant LA et al (1981) Prednisone-induced leukocytosis. Influence of dosage, method and duration of administration on the degree of leukocytosis. Am J Med 71:773–778CrossRefGoogle Scholar
  30. 30.
    Siegel SAR, Winthrop KL (2019) In the real world: infections associated with biologic and small molecule therapies in psoriatic arthritis and psoriasis. Curr Rheumatol Rep 21:36CrossRefGoogle Scholar
  31. 31.
    Singh JA (2016) Infections with biologics in rheumatoid arthritis and related conditions: a scoping review of serious or hospitalized infections in observational studies. Curr Rheumatol Rep 18:61CrossRefGoogle Scholar
  32. 32.
    Smitten AL, Choi HK, Hochberg MC et al (2008) The risk of hospitalized infection in patients with rheumatoid arthritis. J Rheumatol 35:387–393Google Scholar
  33. 33.
    Smolen JS, Genovese MC, Takeuchi T et al (2019) Safety profile of baricitinib in patients with active rheumatoid arthritis with over 2 years median time in treatment. J Rheumatol 46:7–18CrossRefGoogle Scholar
  34. 34.
    Wang S, He Q, Shuai Z (2018) Risk of serious infections in biological treatment of patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a meta-analysis. Clin Rheumatol 37:439–450CrossRefGoogle Scholar
  35. 35.
    Wirz Y, Meier MA, Bouadma L et al (2018) Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care 22:191CrossRefGoogle Scholar
  36. 36.
    Wollenhaupt J, Lee EB, Curtis JR et al (2019) Safety and efficacy of tofacitinib for up to 9.5 years in the treatment of rheumatoid arthritis: final results of a global, open-label, long-term extension study. Arthritis Res Ther 21:89CrossRefGoogle Scholar
  37. 37.
    Yun H, Xie F, Delzell E et al (2015) Risk of hospitalised infection in rheumatoid arthritis patients receiving biologics following a previous infection while on treatment with anti-TNF therapy. Ann Rheum Dis 74:1065–1071CrossRefGoogle Scholar
  38. 38.
    Zink A, Manger B, Kaufmann J et al (2014) Evaluation of the RABBIT Risk Score for serious infections. Ann Rheum Dis 73:1673–1676CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Rheumatologie/Klinische ImmunologieAsklepios Klinikum Bad AbbachBad AbbachDeutschland

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