Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies.

Konstantinos Thomas,Dimitrios Vassilopoulos

doi:10.31138/mjr.31.1.129

Abstract

The third decade of the 21st century marks the beginning of a new era in the treatment of rheumatoid arthritis (RA). Recently, after the introduction in clinical practice of different biologics in the first decade, three different oral synthetic targeted agents (JAK inhibitors) have been licensed for the treatment of RA, in patients who had failed or are intolerant to disease modifying anti-rheumatic drugs (DMARDs). Despite the significant progress that these agents bring to the care of RA patients, the risk of infections is still present and clear, given that their risk for serious infections is at least comparable with that of biologic DMARDs, whereas the incidence of herpes zoster is higher than that of bDMARDs. Here, we review the most recent data regarding the risk for serious and opportunistic infections in RA patients treated with biologics or JAK inhibitors, as well the up-to-date approach for managing and preventing such infections in RA patients.

Highlights

Despite the tremendous improvement that biologic (b-) and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) brought to its management, Rheumatoid arthritis (RA) patients still carry higher mortality compared to the general population; this gap seems to be gradually closing in the recent years.[2]
RA patients have a similar risk for revision, but approximately 60% higher risk for Prosthetic joint infection (PJI), without differences between bDMARD and non-bDMARD treated patients.[28]
In a recent study in a low prevalence country such as Greece, we found that conversion of screening assays (TST, Interferon Gamma Release Assays (IGRAs)) during long-term bDMARD therapy was common and in most cases a transient event.[53]

Summary

INTRODUCTION

Rheumatoid arthritis (RA) is the most common inflammatory arthritis, with an estimated worldwide prevalence between 0.5-1%.1 Despite the tremendous improvement that biologic (b-) and targeted synthetic (ts-) disease-modifying anti-rheumatic drugs (DMARDs) brought to its management, RA patients still carry higher mortality compared to the general population; this gap seems to be gradually closing in the recent years.[2]. Despite their proven efficacy and safety, vaccination uptake in rheumatic patients is low undermining the prevention of several serious infections.[61]

INFECTIONS IN PATIENTS WITTHITRLAE

Findings

CONCLUSIONS