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Rheumatology Advance Access published online on March 31, 2003
Rheumatology, doi:10.1093/rheumatology/keg263
Rheumatology © British Society for Rheumatology 2003; all rights reserved
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© 2003 British Society for Rheumatology 2003; all rights reserved

Original Papers

Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-{alpha} therapy

S. Kroesen 1, A. F. Widmer 2, A. Tyndall 1, P. Hasler 1*

1 Department of Rheumatology, University Hospital
2 Department of Infectious Disease Control, University Hospital, Basel, Switzerl

* Corresponding author. E-mail: paul.hasler{at}ksa.ch.

Received 15 July 2002 ; accepted 3 January 2003

Abstract

Objective. With rising numbers of anti-tumour necrosis factor {alpha} (TNF-{alpha}) treatments for rheumatoid arthritis (RA), Crohn's disease and other conditions, physicians unaware of potential pitfalls are increasingly likely to encounter associated severe infections. Our purpose was to assess the incidence and nature of severe infections in our RA patients under anti-TNF-{alpha} therapy.

Methods. We reviewed patient charts and records of the Infectious Disease Unit for serious infections in patients with RA in the 2 yr preceding anti-TNF-{alpha} therapy and during therapy.

Results. Serious infections affected 18.3% of patients treated with infliximab or etanercept. The incidence was 0.181 per anti-TNF-{alpha} treatment year vs 0.008 in the 2 yr preceding anti-TNF-{alpha} therapy. In several cases, only a few signs or symptoms indicated the severity of developing infections, including sepsis.

Conclusions. A high level of suspicion of infection is necessary in patients under anti-TNF-{alpha} therapy. We suggest additional strategies for the prevention, rapid identification and pre-emptive therapy of such infections.

Key words: TNF-{alpha}, anti-TNF-{alpha} therapy, Infection, Complications, Rheumatoid arthritis.
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