Van Delden Christian
Service des maladies infectieuses, Département de médecine, HUG, 1211 Genève 14.
Rev Med Suisse. 2006 Mar 15;2(57):738-40, 743-5.
Corticosteroids and cytotoxic drugs form the conventional immunomodulators in rheumatology. This therapeutic arsenal has recently been widened by TNF-alpha antagonists and other anti-cytokines. If rheumatoid arthritis is itself associated with infections, immunomodulating therapies further increase the risk of infection, especially when used in combination therapies. Among conventional therapies, corticosteroids are associated with the highest risk for both common bacterial and opportunistic infections. Infliximab is the TNF-alpha antagonist associated with the highest risk of infection. Its use has been particularly associated with cases of severe tuberculosis. All patients at risk for tuberculosis, treated with corticosteroids or TNF-alpha antagonists, should therefore receive an adequate prophylaxis.
皮质类固醇和细胞毒性药物构成了风湿病学中传统的免疫调节剂。近年来，肿瘤坏死因子-α拮抗剂和其他抗细胞因子药物进一步扩充了这一治疗手段。类风湿性关节炎本身就与感染相关，而免疫调节疗法会进一步增加感染风险，尤其是在联合治疗时。在传统疗法中，皮质类固醇与常见细菌感染和机会性感染的风险最高相关。英夫利昔单抗是与感染风险最高相关的肿瘤坏死因子-α拮抗剂。其使用尤其与严重结核病病例相关。因此，所有接受皮质类固醇或肿瘤坏死因子-α拮抗剂治疗的结核病高危患者都应接受充分的预防措施。
