[Increased risk of infection with biological immunomodifying antirheumatic agents. Clear guidelines are necessary as...

Area of Science:

• Immunology
• Infectious Diseases
• Rheumatology

Background:

• The advent of novel immunosuppressive drugs has expanded treatment options for autoimmune conditions.
• Patients with rheumatologic diseases, Crohn's disease, and other autoimmune disorders are often prescribed these potent medications.

Observation:

• Five patient cases are presented from Växjö central hospital, detailing severe infections including Listeria meningitis, sepsis, Pneumocystis jiroveci pneumonia, tuberculosis pneumonia, and Legionella pneumonia.
• Rheumatoid arthritis (RA) patients exhibit a doubled risk of infections compared to healthy individuals.
• Tumor Necrosis Factor (TNF) antagonists are associated with an increased risk of tuberculosis and opportunistic infections like listeriosis, mycobacteriosis, and invasive fungal infections.

Findings:

• TNF plays a critical role in immune defense, and its inhibition elevates the risk of opportunistic pathogens.
• Tuberculosis screening is now mandatory for patients initiating TNF antagonist therapy due to heightened tuberculosis risk.
• A registry (South Swedish Arthritis Treatment Group, SSATG) tracks TNF blocker use in rheumatologic diseases across eight southern Swedish hospitals.

Implications:

• Guidelines for tuberculosis screening and treatment, prophylactic antibiotic use for endocarditis, and vaccination programs are essential for patients on TNF antagonists.
• Proactive management strategies are necessary to mitigate the increased susceptibility to severe infections in patients undergoing immunosuppressive therapy.
• This highlights the need for vigilant monitoring and tailored preventive care in managing patients with autoimmune diseases on advanced therapies.