title: Factors associated with severe skin infections in patients treated with biologic therapies for inflammatory rheumatic diseases.
abstract: BACKGROUND
  The incidence of severe infections is increased under biologic therapies and the skin is the second localization.
  
  
  OBJECTIVE
  To appraise the factors associated with severe skin infections (SSI) in patients under biologic therapies for inflammatory rheumatic diseases (IRD).
  
  
  METHODS
  We performed a case-control (ratio 1:3) study nested in a prospective cohort of patients with IRD. SSI was defined as requiring hospitalization or intravenous anti-infectious therapy. We defined two imbedded periods: period A was the time window between the first biologic therapy and the SSI; period B was the last 3 or 12 months (for tumor necrosis factor blockers or rituximab, respectively) before the SSI.
  
  
  RESULTS
  Among 4,361 patients with IRD, 29 had a SSI under biologic therapy. In multivariate analyses, SSI were significantly associated with smoking, baseline C-reactive protein and gammaglobulinemia, non-steroidal anti-inflammatory drugs before biologic therapy, cumulative dose of steroids, concomitant steroids during period A, number of different biologic therapies during period A, treatment with infliximab during period A, period B or as first biologic therapy and treatment at high dose during period B.
  
  
  CONCLUSIONS
  In patients under biologic therapies for IRD, the risk of SSI is associated with several factors including tobacco, treatment with infliximab or high dose range.
authors.affiliation: Department of Dermatology, Hôpital Cochin, APHP, Université René Descartes Paris V, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Régnier-Rosencher
authors.forename: D
authors.initials: D
authors.lastname: Farhi
authors.forename: A
authors.initials: A
authors.lastname: Lebrun
authors.forename: C
authors.initials: C
authors.lastname: Salliot
authors.forename: M
authors.initials: M
authors.lastname: Dougados
authors.forename: N
authors.initials: N
authors.lastname: Dupin
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001688:Biological Products / Q000009:adverse effects*; D016022:Case-Control Studies; D015331:Cohort Studies; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016032:Randomized Controlled Trials as Topic; D018124:Receptors, Tumor Necrosis Factor; D012216:Rheumatic Diseases / Q000188:drug therapy*; D012307:Risk Factors; D000069283:Rituximab; D012720:Severity of Illness Index; D012874:Skin Diseases, Infectious / Q000139:chemically induced*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D001688:Biological Products; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069283:Rituximab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept