DMARDS and infections in rheumatoid arthritis

Area of Science:

• Rheumatology
• Immunology
• Infectious Diseases

Background:

• Rheumatoid arthritis (RA) patients exhibit increased susceptibility to infections, potentially due to immune dysregulation or immunosuppressive therapies.
• The precise infectious risk associated with conventional disease-modifying anti-rheumatic drugs (DMARDs) requires further clarification.
• Understanding these risks is crucial for optimizing patient management and preventing infection-related morbidity and mortality.

Purpose of the Study:

• To evaluate the infection risk in patients with rheumatoid arthritis (RA) treated with conventional disease-modifying anti-rheumatic drugs (DMARDs).
• To review the current evidence regarding the safety profiles of methotrexate (MTX) and leflunomide (LEF) in relation to infection risk.
• To provide recommendations for the careful use and monitoring of DMARDs in RA patients.

Main Methods:

• Systematic review of existing literature on DMARDs and infection risk in RA patients.
• Analysis of data concerning methotrexate (MTX) and leflunomide (LEF) and their association with infections like pneumonia.
• Assessment of infection-related adverse events and reasons for therapy discontinuation.

Main Results:

• Methotrexate (MTX) may increase infectious risk, but its disease-modulating effects can reduce other infection risk factors.
• Leflunomide (LEF) appears safe in trials but has been linked to hospitalizations for infections, including pneumonia.
• Data on other DMARDs are limited, with toxicity other than infection being the primary reason for treatment cessation.

Conclusions:

• DMARDs generally have a favorable profile regarding infectious risk in RA patients.
• Close patient monitoring and judicious use of DMARDs are essential to mitigate potential infection risks.
• Further research is needed to fully elucidate the infectious risks associated with various DMARDs in RA management.