Caporali Roberto, Caprioli Marta, Bobbio-Pallavicini Francesca, Montecucco Carlomaurizio
Rheumatology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
Autoimmun Rev. 2008 Dec;8(2):139-43. doi: 10.1016/j.autrev.2008.05.001. Epub 2008 Jun 9.
Patients with rheumatoid arthritis (RA) has an increased infections risk and morbidity and mortality related to infections. This increased risk may occur due to the disease itself with intrinsic cellular immunity alterations or as a results of drugs used to control the disease. The potential risk of infections related to conventional disease modifying anti-rheumatic drugs (DMARDs) is not completely clarified. Methotrexate (MTX) may increase the infectious risk, but its positive effect on disease activity results in a reduction of further risk factors for infections. Data about the increased risk of pneumonia or reactivation of silent infection remain controversial. Leflunomide (LEF) seems safe in controlled trial even if it has been associated with the onset of infections requiring hospitalization, such as pneumonia. Data about other DMARDs are scanty and the main cause of interruption of therapy is related to toxicity different from infection. Beside the general positive profile of DMARDs as for infectious risk, a careful use and tight control of the patients is recommended.
类风湿关节炎（RA）患者发生感染的风险增加，且与感染相关的发病率和死亡率也有所上升。这种风险增加可能是由于疾病本身导致固有细胞免疫改变，或者是用于控制疾病的药物所致。与传统改善病情抗风湿药（DMARDs）相关的感染潜在风险尚未完全阐明。甲氨蝶呤（MTX）可能会增加感染风险，但其对疾病活动的积极作用会降低进一步的感染风险因素。关于肺炎风险增加或潜伏感染再激活的数据仍存在争议。来氟米特（LEF）在对照试验中似乎是安全的，尽管它曾与需要住院治疗的感染（如肺炎）的发生有关。关于其他DMARDs的数据很少，治疗中断的主要原因与感染以外的毒性有关。除了DMARDs在感染风险方面总体呈阳性外，建议谨慎使用并严格控制患者。
