¿Son los fármacos biológicos antirreumáticos nuestros nuevos enemigos?.

Abstract

Introduction: The aim of this paper is to review and update the information available to date on the influence of diseasemodifying antirheumatic drugs on increased risk of infections after prosthetic surgery or osteosynthesis, and the presentation of a clinical case of infection in a patient operated on for a tibia fracture, that was being treated with Secukinumab. Clinical Case: A 70-year-old patient with psoriatic arthritis treated with Secukinumab and low-dose methotrexate, who suffered a Schatzker type II fracture of the external tibial plateau, operated on by reduction and osteosynthesis with a screwed plate and contribution of cancellous bone tissue. The patient evolved towards deep infection, isolating Actinomyces Neuii. After an early approach with washing and local debridement, the infection was not resolved, so it was necessary to remove the material, clean it, and add Bioglass (Bonalife), given the clinical deterioration of the patient. Antibiotherapy was associated with Linezolid, Clindamycin, with favorable evolution in the resolution of the infection. Discussion and conclusions: Secukinumab is a monoclonal antibody that belongs to the group of drugs known as "interleukin inhibitors", which works by neutralizing the activity of a protein called IL-17A, present in high amounts in diseases such as psoriasis, psoriatic arthritis and axial spondyloarthritis. The current recommendations for the management of rheumatic patients under treatment with biological drugs, who are going to undergo hip or knee prosthetic surgery, is to perform it at the end of the half-life of each drug, but in the case of surgical intervention due to fracture, not there is no recommendation, so extreme precautions must be taken to avoid infection, assessing in each case whether greater antibiotic prophylaxis is necessary.