title: [Increased risk of infection with biological immunomodifying antirheumatic agents. Clear guidelines are necessary as shown by case reports].
abstract: Several potent immunosuppressive drugs have become available in the new millennium for patients with rheumatologic diseases, Crohn's disease and other autoimmune disorders. Five patient cases from Växjö central hospital (uptake area 178 000 individuals) with Listeria meningitis, Pneumocystis jiroveci and tuberculosis pneumonia, Listeria sepsis, Legionella pneumonia and E coli sepsis are described. A doubled risk for infections has previously been observed for RA patients, as compared to healthy individuals. There is clearly an increased risk of tuberculosis (depending on the actual and historic environmental prevalence) for patients on TNF antagonists, and therefore tuberculosis screening is now mandatory before start of therapy. Since TNF has a central role in the immune defence, an increased risk of opportunistic infections like listeriosis. mycobacteriosis, and invasive fungal infections has been established. Eight hospitals in southern Sweden participate in a register for the use of TNF blockers in rheumatologic diseases (South Swedish Arthritis Treatment Group, SSATG). Guidelines for screening and treatment of latent and active tuberculosis, possible prophylactic antibiotic treatment for endocarditis and vaccination programs for patients on TNF antagonists are discussed.
authors.affiliation: Reumatikersjukhuset i Spenshult.
authors.forename: Maria
authors.initials: M
authors.lastname: Söderlin
authors.forename: Christian
authors.initials: C
authors.lastname: Blomkvist
authors.forename: Per
authors.initials: P
authors.lastname: Dahl
authors.forename: Per
authors.initials: P
authors.lastname: Forsberg
authors.forename: Jan
authors.initials: J
authors.lastname: Fohlman
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D004927:Escherichia coli Infections / Q000209:etiology / Q000276:immunology; D000068800:Etanercept; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab; D053590:Interleukin 1 Receptor Antagonist Protein; D007876:Legionellosis / Q000209:etiology / Q000276:immunology; D008297:Male; D008584:Meningitis, Listeria / Q000209:etiology / Q000276:immunology; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000009:adverse effects; D009894:Opportunistic Infections / Q000209:etiology / Q000276:immunology / Q000382:microbiology*; D011020:Pneumonia, Pneumocystis / Q000209:etiology / Q000276:immunology; D018124:Receptors, Tumor Necrosis Factor; D047889:Receptors, Tumor Necrosis Factor, Type II; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000276:immunology / Q000382:microbiology; D012795:Sialoglycoproteins / Q000009:adverse effects*; D014376:Tuberculosis / Q000209:etiology / Q000276:immunology; D053319:Tumor Necrosis Factor Decoy Receptors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; C507763:IL1RN protein, human; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D053590:Interleukin 1 Receptor Antagonist Protein; D009363:Neoplasm Proteins; D018124:Receptors, Tumor Necrosis Factor; D047889:Receptors, Tumor Necrosis Factor, Type II; D012795:Sialoglycoproteins; D053319:Tumor Necrosis Factor Decoy Receptors; D000069285:Infliximab; D000068800:Etanercept