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Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-alpha therapy

S Kroesen1, A F Widmer, A Tyndall

  • 1Department of Rheumatology, University Hospital, Basel, Switzerland.

Rheumatology (Oxford, England)
|April 24, 2003
PubMed
Abstract

Insights

Anti-tumour necrosis factor alpha (TNF-alpha) therapy for rheumatoid arthritis (RA) significantly increases the risk of severe infections. Vigilance for infections is crucial during anti-TNF-alpha treatment.

Area of Science:

  • Immunology
  • Rheumatology
  • Infectious Diseases

Background:

  • Anti-tumour necrosis factor alpha (TNF-alpha) therapies are increasingly used for rheumatoid arthritis (RA) and other autoimmune conditions.
  • Physicians may be unaware of the significant risk of severe infections associated with these treatments.

Purpose of the Study:

  • To assess the incidence and nature of severe infections in RA patients undergoing anti-TNF-alpha therapy.
  • To highlight the increased risk of infection compared to the pre-treatment period.

Main Methods:

  • Retrospective review of patient charts and Infectious Disease Unit records.
  • Analysis of serious infections in RA patients for two years prior to and during anti-TNF-alpha therapy.

Main Results:

  • 18.3% of patients on infliximab or etanercept experienced serious infections.
  • The incidence of serious infections was substantially higher during anti-TNF-alpha therapy (0.181 per treatment year) compared to the preceding period (0.008 per year).
  • Some severe infections, including sepsis, presented with subtle signs and symptoms.

Conclusions:

  • A high index of suspicion for infections is essential in patients receiving anti-TNF-alpha therapy.
  • Enhanced strategies for infection prevention, rapid identification, and preemptive treatment are recommended.

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