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Individual Drugs in Rheumatology and the Risk of Infection

  • Konstantinos Thomas
  • Dimitrios Vassilopoulos
Chapter

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.

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