Comorbid infections in patients with rheumatoid arthritis
https://doi.org/10.14412/1996-7012-2014-2-21-27
Abstract
The problem of comorbid infections (CI) in modern rheumatology remains important. The reasons behind it include the presence of an autoimmune rheumatic disease and the need to use immunosuppressant drugs. We discuss some problems of CI under EULAR recommendations (2013) for the management of rheumatoid arthritis (RA). The incidence rates of comorbid infections in patients treated with different disease- modifying anti-rheumatic and biological drugs are analyzed. The significance of measures for preventing CI in management of RA patients is demonstrated. The significance of vaccination (first of all, with anti-influenza and pneumococcal vaccines) of RA patients to reduce the incidence rate of lower respiratory tract infections and the risk of infection-related mortality is emphasized. Vaccination is recommended even if suboptimal outcome is expected.
About the Author
B.S. Belov
V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, Moscow, Russia
Russian Federation
Russian Federation
References
1. Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the man- agement of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014 Mar;73(3):492–509. DOI: 10.1136/annrheumdis-2013-204573. Epub 2013 Oct 25.
2. Насонов ЕЛ, Каратеев ДЕ, Чичасова НВ. Рекомендации EULAR по лечению ревматоидного артрита-2013: общая характеристика и дискуссионные проблемы. Научно-практическая ревматология. 2013;51(6): 609–22. [Nasonov EL, Karateev DE, Chichasova NV. EULAR recommendations for the treatment of rheumatoid arthritis-2013: general characteristics and disputable problems. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2013;51(6):609–22 (In Russ.)]. DOI: http://dx.doi.org/10.14412/1995-4484-2013-609-22.
3. Wolfe F, Mitchell DM, Sibley JT. The mortality of rheumatoid arthritis. Arthritis Rheum. 1994;37(4):481–94. DOI: http://dx.doi.org/10.1002/art.1780370408.
4. Doran MF, Crowson CS, Pond GR, et al. Frequency of infection in patients with rheumatoid arthritis compared with controls. Arthritis Rheum. 2002;46(9):2287–93. DOI: 10.1002/art.10524.
5. Белов БС, Балабанова РМ, Манукян СГ и др. Коморбидные инфекции при ревматических заболеваниях. Тезизы докладов международной конференции ревматологов. Чимкент, 2006. С. 17. [Belov BS, Balabanova RM, Manukyan SG, et al. Komorbidnyie infektsii pri revmaticheskih zabolevaniyah [Komorbidnyie infektsii pri revmaticheskih zabolevaniyah]. Tezizy dokladov mezhdunarodnoi konferentsii revmatologov. Chimkent; 2006. Р. 17].
6. Perhala RS, Wilke WS, Clough JD, Segal AM. Local infectious complications following large joint replacement in rheumatoid arthritis patients treated with methotrexate versus those not treated with methotrexate. Arthritis Rheum. 1991;34(2):146–52. DOI: http://dx.doi.org/10.1002/art.1780340204.
7. Van der Veen MJ, van der Heide A, Kruize AA, Bijlsma JW. Infection rate and use of antibiotics in patients with rheumatoid arthritis treated with methotrexate. Ann Rheum Dis. 1994;53(4):224–8. DOI: http://dx.doi.org/10.1136/ard.53.4.224.
8. Boerbooms AM, Kerstens PJ, van Loenhout JW, et al. Infections during lowdose methotrexate treatment in rheumatoid arthritis. Semin Arthritis Rheum. 1995;24(6):411–21. DOI: http://dx.doi.org/10.1016/S0049-0172(95)80009-3.
9. Schnabel A, Burchardi C, Gross WL. Major infection during methotrexate treatment for rheumatoid arthritis. Semin Arthritis Rheum. 1996;25(5):357–9. DOI: http://dx.doi.org/10.1016/S0049-0172(96)80021-7.
10. Doran MF, Crowson CS, Pond GR, et al. Predictors of infection in rheumatoid arthritis. Arthritis Rheum. 2002 Sep;46(9):2294–300. DOI: 10.1002/art.10529.
11. Wolfe F, Caplan L, Michaud K. Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy. Arthritis Rheum. 2006;54(2):628–34. DOI: 10.1002/art.21568.
12. Bernatsky S, Hudson M, Suissa S. Antirheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology (Oxford). 2007;46(7):1157–60. DOI:10.1093/rheumatology/kem076.
13. Greenberg JD, Reed G, Kremer JM, et al.; CORRONA Investigators. Association of methotrexate and tumour necrosis factor antagonists with risk of infectious outcomes including opportunistic infections in the CORRONA registry. Ann Rheum Dis. 2010 Feb;69(2):380–6. DOI: 10.1136/ard.2008.089276.
14. Widdifield J, Bernatsky S, Paterson JM, et al. Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res. 2013 Mar;65(3):353–61. DOI: 10.1002/acr.21812.
15. LeMense GP, Sahn SA. Opportunistic infection during treatment with low dose methotrexate. Am J Respir Crit Care Med. 1994;150(1):258–60. DOI: http://dx.doi.org/10.1164/ajrccm.150.1.8025760.
16. O'Reilly S, Hartley P, Jeffers M, et al. Invasive pulmonary aspergillosis associated with low dose methotrexate therapy for rheumatoid arthritis: a case report of treatment with itraconazole. Tuber Lung Dis. 1994 Apr;75(2):153–5.
17. Binymin K, Cooper RG. Late reactivation of spinal tuberculosis by low-dose methotrexate therapy in a patient with rheumatoid arthritis. Rheumatology (Oxford). 2001 Mar;40(3):341–2. DOI: 10.1093/rheumatology/40.3.341.
18. Lach B, Connolly B, WЯthrich C, Koralnik IJ. Inflammatory infratentorial progressive multifocal leukoencephalopathy in a patient with rheumatoid arthritis. Neuropathology. 2014 Feb;34(1):39–44. DOI: 10.1111/neup.12045.
19. Cohen S, Cannon GW, Schiff M, et al. Two-year, blinded, randomized, controlled trial of treatment of active rheumatoid arthritis with leflunomide compared with methotrexate. Utilization of Leflunomide in the Treatment of Rheumatoid Arthritis Trial Investigator Group. Arthritis Rheum. 2001 Sep;44(9):1984–92. DOI: 10.1002/1529-0131(200109)44:9<1984::AID-ART346>3.0.CO;2-B.
20. Yoo HG, Yu HM, Jun JB, et al. Risk factors of severe infections in patients with rheumatoid arthritis treated with leflunomide. Mod Rheumatol. 2013 Jul;23(4):709–15. DOI: 10.1007/s10165-012-0716-8.
21. Jenks KA, Stamp LK, O'Donnell JL, et al. Leflunomide-associated infections in rheumatoid arthritis. J Rheumatol. 2007;34(11):2201–3.
22. Franklin J, Lunt M, Bunn D, et al. Risk and predictors of infection leading to hospitalisation in a large primary-care-derived cohort of patients with inflammatory polyarthritis. Ann Rheum Dis. 2007;66(3):308–12. DOI: 10.1136/ard.2006.057265.
23. Lacaille D, Guh DP, Abrahamowicz M, et al. Use of nonbiologic disease-modifying antirheumatic drugs and risk of infection in patients with rheumatoid arthritis. Arthritis Rheum. 2008;59(8):1074–81. DOI: 10.1002/art.23913.
24. Smitten AL, Choi HK, Hochberg MC, et al. The risk of hospitalized infection in patients with rheumatoid arthritis.
25. J Rheumatol. 2008; 35(3):387–93.
26. Dixon WG, Abrahamowicz M, Beauchamp ME, et al. 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. 2012 Jul;71(7):1128–33. DOI: 10.1136/annrheumdis-2011-200702.
27. Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology (Oxford). 2013;52(1):53–61. DOI: 10.1093/rheumatology/kes305.
28. Curtis JR, Patkar N, Xie A, et al. Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor alpha antagonists. Arthritis Rheum. 2007;56(4):1125–33. DOI: 10.1002/art.22504.
29. Galloway JB, Hyrich KL, Mercer LK, et al.; BSRBR Control Centre Consortium; British Society for Rheumatology Biologics Register. Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology (Oxford). 2011;50(1):124–131. DOI: 10.1093/rheumatology/keq242.
30. Atzeni F, Sarzi-Puttini P, Botsios C, et al. Long-term anti-TNF therapy and the risk of serious infections in a cohort of patients with rheumatoid arthritis: comparison of adalimumab, etanercept and infliximab in the GISEA registry. Autoimmun Rev. 2012 Dec;12(2):225–9. DOI: 10.1016/j.autrev.2012.06.008.
31. Van Dartel SA, Fransen J, Kievit W, et al. Predictors for the 5-year risk of serious infections in patients with rheumatoid arthritis treated with anti-tumour necrosis factor therapy: a cohort study in the Dutch Rheumatoid Arthritis Monitoring (DREAM) registry. Rheumatology (Oxford). 2013;52(6):1052–7. DOI: 10.1093/rheumatology/kes413.
32. Che H, Lukas C, Morel J, Combe B. Risk of herpes/herpes zoster during anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Systematic review and meta-analysis. Joint Bone Spine. 2013 Aug 7. pii: S1297–319X(13)00194–2. DOI: 10.1016/j.jbspin.2013.07.009.
33. Saag KG, Winthrop KL, Alexander K, et al. Long-term safety event rates in RA patients following inirtiation of rituximab: interim analysis fron SUNSTONE registry. Arthritis Rheum. 2013;65 Suppl 10:1002.
34. Gottenberg JE, Ravaud P, Bardin T, et al.; French Society of Rheumatology. Prospective follow-up of RA patients (1200 patient/years) treated with abatacept in real life: results from the ORA registry. Ann Rheum Dis. 2011;70 Suppl 3:466.
35. Schiff MH, Kremer JM, Jahreis A, et al. Integrated safety in tocilizumab clinical trials. Arthritis Res Ther. 2011;13(5):R141. DOI: 10.1186/ar3455.
36. Yazici Y, Curtis JR, Ince A, et al. Efficacy of tocilizumab in patients with moderate to severe active rheumatoid arthritis and a previous inadequate response to disease-modifying antirheumatic drugs: the ROSE study. Ann Rheum Dis. 2012;71(2):198–205. DOI: 10.1136/ard.2010.148700.
37. Morel J, Duzanski MO, Bardin T, et al. Prospective follow-up of tocilizumab treatment in 764 patients with refractory rheumatoid arthritis: tolerance and efficacy data from the French registry Regate (REGistryRoAcTEmra. Arthritis Rheum. 2012;64 Suppl 10:152.
38. Genovese MC, Rubbert-Roth A, Smolen JS, et al. Long-term safety and efficacy of tocilizumab in patients with rheumatoid arthritis: a cumulative analysis of up to 4.6 years of exposure. J Rheumatol. 2013;40(6):768–80. DOI: 10.3899/jrheum.120687.
39. Koike T, Harigai M, Inokuma S, et al. Effectiveness and safety of tocilizumab: postmarketing surveillance of 7901 patients with rheumatoid arthritis in Japan. J Rheumatol. 2014;41(1):15–23. DOI: 10.3899/jrheum.130466.
40. Burmester GR, Charles-Schloeman C, Isaacs JD, et al. Tofacitinib, an oral Janus kinase inhibitor: safety comparisonin patients with rheumatoid arthritis and an inadequate response to nonbiologic or biologic disease-modifying anti-rheumatic drugs. Arthritis Rheum. 2013;65 Suppl 10:192.
41. Wollenhaupt J, Silverfield J, Lee EB, et al. Safety and Efficacy of Tofacitinib, an Oral Janus Kinase Inhibitor, for the Treatment of Rheumatoid Arthritis in Open-label, Longterm Extension Studies. J Rheumatol. 2014 Apr 1. [Epub ahead of print]. DOI: 10.3899/jrheum.130683.
42. Борисов СЕ, Лукина ГВ. Рекомендации по скринингу и мониторингу туберкулезной инфекции у больных, получающих генно-инженерные биологические препараты. Доступ по ссылке: www.rheumatolog.ru/files/natrec21/.pdf. [Borisov SE, Lukina GV. Rekomendatsii po skriningu i monitoringu tuberkuleznoy infektsii u bolnyih, poluchayuschih genno-inzhenernyie biologicheskie preparatyi [Recommendations about screening and monitoring of a tubercular infection at the patients receiving genetically engineered biological preparations]. Available from: www.rheumatolog.ru/files/natrec21/.pdf.].
43. Caporali R, Bobbio-Pallavicini F, Atzeni F, et al. Safety of tumor necrosis factor alpha blockers in hepatitis B virus occult carriers (hepatitis B surface antigen negative/antihepatitis B core antigen positive) with rheumatic diseases. Arthritis Care Res (Hoboken). 2010;62(6):749–54. DOI: 10.1002/acr.20130.
44. Mori S. Past hepatitis B virus infection in rheumatoid arthritis patients receiving biological and/or nonbiological disease-modifying antirheumatic drugs. Mod Rheumatol. 2011;21(6):621–7. DOI: 10.1007/s10165-011-0458-z
45. Urata Y, Uesato R, Tanaka D, et al. Prevalence of reactivation of hepatitis B virus replication in rheumatoid arthritis patients. Mod Rheumatol. 2011;21(1):16–23. DOI: 10.1007/s10165-010-0337-z.
46. Tan J, Zhou J, Zhao P, Wei J. Prospective study of HBV reactivation risk in rheumatoid arthritis patients who received conventional disease-modifying antirheumatic drugs. Clin Rheumatol. 2012;31(8):1169–75. DOI: 10.1007/s10067-012-1988-2.
47. Шекшина ЕВ, Балабанова РМ. Инфекция и ревматоидный артрит: некоторые аспекты диагностики и лечения. Инфекции и антимикробная терапия. 2003;5(3):3–8.[Shekshina EV, Balabanova RM. Infection and rheumatoid arthritis: some aspects of diagnostics and treatment. Infektsii i antimikrobnaya terapiya. 2003;5(3):3–8].
48. Furst DE, Keystone EC, So AK, et al. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2012. Ann Rheum Dis. 2013;72 Suppl 2:2–34. DOI: 10.1136/annrheumdis-2013-203348.
49. Carroll MB. The impact of biologic response modifiers on hepatitis B virus infection. Expert Opin Biol Ther. 2011;11(4):533–44. DOI: 10.1517/14712598.2011.554810.
50. Pyrpasopoulou A, Douma S, Vassiliadis T, et al. Reactivation of chronic hepatitis B virus infection following rituximab administration for rheumatoid arthritis. Rheumatol Int. 2011;31(3):403–4. DOI: 10.1007/s00296-009-1202-2.
51. Rodriguez-Escalera C, Fernandez-Nebro A. The use of rituximab to treat a patient with ankylosing spondylitis and hepatitis B. Rheumatology (Oxford). 2008;47(11):1732–3. DOI: 10.1093/rheumatology/ken362.
52. Tsutsumi Y, Kanamori H, Mori A, et al. Reactivation of hepatitis B virus with rituximab. Expert Opin Drug Saf. 2005;4(3):599–608. DOI: 10.1517/14740338.4.3.599.
53. Montiel PM, Solis JA, Chirinos JA, et al. Hepatitis B virus reactivation during therapy with etanercept in an HBsAg-negative and anti-HBs-positive patient. Liver Int. 2008;28(5):718–20. DOI: 10.1111/j.1478-3231.2007.01665.x.
54. Charpin C, Guis S, Colson P, et al. Safety of TNF-blocking agents in rheumatic patients with serology suggesting past hepatitis B state: results from a cohort of 21 patients. Arthritis Res Ther. 2009;11(6):R179. DOI: 10.1186/ar2868.
55. Available from: http://www.aasld.org/practiceguidelines/Doc uments/ Bookmarked%20Practice%20Guidelines/Chr onic_Hep_B_Update_ 2009%208_24_2009.pdf.
56. European Association for the Study of the Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol. 2012;57(1):167–85. DOI: 10.1016/j.jhep.2012.02.010.
57. Bengtsson C, Kapetanovic MC, KКllberg H, et al.; EIRA Study Group. Common vaccinations among adults do not increase the risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Ann Rheum Dis. 2010;69(10):1831–3. DOI: 10.1136/ard.2010.129908.
58. Brunasso AM, Puntoni M, Gulia A, Massone C. Safety of anti-tumour necrosis factor agents in patients with chronic hepatitis C infection: a systematic review. Rheumatology (Oxford). 2011;50(9):1700–11. DOI: 10.1093/rheumatology/ker190.
59. Pham T, Claudepierre P, Constantin A, et al. Abatacept therapy and safety management. Joint Bone Spine. 2009;76 Suppl 1:S3–55. DOI: 10.1016/S1297-319X(09)74520-8.
60. Kavanaugh A. Infection prophylaxis in antirheumatic therapy: emphasis on vaccination. Curr Opin Rheumatol. 2009;21(4):419–24. DOI: 10.1097/BOR.0b013e328329ec6e
61. Salemi S, D'Amelio R. Are anti-infectious vaccinations safe and effective in patients with autoimmunity? Int Rev Immunol. 2010;29(3):270–314. DOI: 10.3109/08830185.2010.483028.
62. Brezinschek HP, Hofstaetter T, Leeb BF, et ak. Immunization of patients with rheumatoid arthritis with antitumor necrosis factor alpha therapy and methotrexate. Curr Opin Rheumatol. 2008;20(3):295–9. DOI: 10.1097/BOR.0b013e3282ffdeca.
Review
For citations:
Belov B. Comorbid infections in patients with rheumatoid arthritis. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2014;8(2):21-27. (In Russ.) https://doi.org/10.14412/1996-7012-2014-2-21-27
Views:
1451
Email this article 