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Individual Drugs in Rheumatology and the Risk of Infection

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Book cover The Microbiome in Rheumatic Diseases and Infection

Abstract

The advances in the therapeutics of rheumatic patients with the introduction of biologic therapies have led to a better control of diseases with inadequate response to conventional treatments and to an improvement of the functional status of these patients. Despite this progress, the risk of infections in patients under biologic or conventional treatments has not been reduced, partly because more elderly patients or patients with comorbidities are considered eligible for immunosuppressive or disease-modifying treatments. Rheumatologists should be aware of the specific patterns of infection risk that accompany these, especially the newer, treatments and should be vigilant for signs and symptoms of infection in patients with rheumatic diseases. Appropriate screening for and treatment of chronic hepatitis B virus infection and latent tuberculosis significantly reduce the risk for reactivation in patients under therapy. Chemoprophylaxis of patients susceptible for Pneumocystis jirovecii pneumonia eliminates almost completely the risk for acquisition of this potentially lethal infection in eligible patients. Appropriate vaccinations of rheumatic patients treated with antirheumatic therapies should be part of the daily clinical practice of physicians caring for patients with rheumatic diseases.

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Abbreviations

AAV:

ANCA-associated vasculitis

ABA:

Abatacept

ADA:

Adalimumab

ANA:

Anakinra

ANCA:

Antineutrophil cytoplasmic antibody

Anti-HBc:

Antibody against hepatitis B core antigen

Anti-HBs:

Antibody against hepatitis B surface antigen

AOSD:

Adult-onset Still’s disease

AS:

Ankylosing spondylitis

AZA:

Azathioprine

BAFF:

B-cell activating factor

BCG:

Bacillus Calmette-Guérin

bDMARDs:

Biologic disease-modifying antirheumatic drugs

CAPS:

Cryopyrin-associated periodic syndromes

CD:

Cluster of differentiation

CNS:

Central nervous system

CRP:

C-reactive protein

CsA:

Cyclosporine A

csDMARDs:

Conventional synthetic disease-modifying antirheumatic drugs

CYC:

Cyclophosphamide

EDTA:

European Dialysis and Transplantation Association

EMA:

European Medicines Agency

ETN:

Etanercept

EULAR:

European League Against Rheumatism

FDA:

Food and Drug Administration

GCA:

Giant-cell arteritis

HBsAg:

Hepatitis B surface antigen

HBV:

Hepatitis B virus

HZ:

Herpes zoster

Ig:

Immunoglobulin

IGRA:

Interferon-gamma releasing assay

IL:

Interleukin

INFL:

Infliximab

IV:

Intravenous

IVIG:

Intravenous immunoglobulin

JAK:

Janus kinase

JIA:

Juvenile idiopathic arthritis

LEF:

Leflunomide

LN:

Lupus nephritis

LON:

Late-onset neutropenia

LTBI:

Latent tuberculosis infection

LTE:

Long-term extension

MMF:

Mycophenolate mofetil

MTX:

Methotrexate

NSAIDs:

Nonsteroidal anti-inflammatory drugs

NTM:

Nontuberculous mycobacteria

OIs:

Opportunistic infections

PDE4:

Phosphodiesterase-4

PJP:

Pneumocystis jirovecii pneumonia

PML:

Progressive multifocal leukoencephalopathy

PMR:

Polymyalgia rheumatica

PsA:

Psoriatic arthritis

RA:

Rheumatoid arthritis

RCT:

Randomized controlled trial

RTX:

Rituximab

SC:

Subcutaneous

SLE:

Systemic lupus erythematosus

TB:

Tuberculosis

TCZ:

Tocilizumab

TMP/SMX:

Trimethoprim/sulfamethoxazole

TNF:

Tumor necrosis factor

TNFi:

TNF inhibitors

TST:

Tuberculin skin test

VZV:

Varicella-zoster virus

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Authors and Affiliations

  1. Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens, School of Medicine, Hippokration General Hospital, Athens, Greece

    Konstantinos Thomas & Dimitrios Vassilopoulos

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  1. Konstantinos Thomas
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  2. Dimitrios Vassilopoulos
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Correspondence to Dimitrios Vassilopoulos .

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  1. Faculty of Medicine, Cairo University, Cairo, Egypt

    Gaafar Ragab

  2. University of Alabama, Birmingham, Alabama, USA

    T. Prescott Atkinson

  3. University of Alabama, Birmingham, Alabama, USA

    Matthew L. Stoll

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Thomas, K., Vassilopoulos, D. (2018). Individual Drugs in Rheumatology and the Risk of Infection. In: Ragab, G., Atkinson, T., Stoll, M. (eds) The Microbiome in Rheumatic Diseases and Infection. Springer, Cham. https://doi.org/10.1007/978-3-319-79026-8_34

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