Crawford Monica, Curtis Jeffrey R
Curr Rheumatol Rep. 2008 Oct;10(5):383-9. doi: 10.1007/s11926-008-0062-1.
Rheumatoid arthritis patients are at heightened risk for infections because of intrinsic disease severity with associated inflammation, comorbid illnesses, and use of glucocorticoids and various immunosuppressives. Although several studies have reported up to a twofold increase in risk of serious infections in RA patients treated with anti-tumor necrosis factor-alpha agents, results from other studies have been conflicting. Comparing results from different studies is challenging because of differences in patient populations, heterogeneous prevalence of comorbidities, and differing patterns of concomitant medication use. Based on available evidence, an excess risk for infection occurs early after initiation of tumor necrosis factor-alpha inhibitor therapy. Additionally, special circumstances such as surgical procedures may increase infection risk. The appropriate use of biologics in the perioperative setting remains empiric at best.
类风湿性关节炎患者由于内在疾病严重程度以及相关炎症、合并症，同时使用糖皮质激素和各种免疫抑制剂，因此感染风险增加。尽管多项研究报告称，接受抗肿瘤坏死因子-α药物治疗的类风湿性关节炎患者发生严重感染的风险增加了两倍，但其他研究结果却相互矛盾。由于患者群体不同、合并症患病率各异以及伴随用药模式不同，比较不同研究的结果具有挑战性。根据现有证据，在开始使用肿瘤坏死因子-α抑制剂治疗后早期会出现额外的感染风险。此外，诸如外科手术等特殊情况可能会增加感染风险。在围手术期合理使用生物制剂充其量仍只是经验性的。
