Wong Peter K K, Bagga Hanish, Barrett Claire, Hanrahan Paddy, Johnson Doug, Katrib Amel, Leder Karin, Marabani Mona, Pentony Peta, Riordan John, White Ray, Young Laurel
Mid-North Coast Arthritis Clinic, Coffs Harbour, New South Wales, Australia.
UNSW Rural Clinical School, Coffs Harbour, New South Wales, Australia.
Intern Med J. 2017 May;47(5):491-500. doi: 10.1111/imj.13371.
Autoimmune inflammatory rheumatic diseases (AIIRD), such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis are often complicated by infection, which results in significant morbidity and mortality. The increased risk of infection is probably due to a combination of immunosuppressive effects of the AIIRD, comorbidities and the use of immunosuppressive conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) and more recently, targeted synthetic DMARDs and biologic DMARDs that block specific pro-inflammatory enzymes, cytokines or cell types. The use of these various DMARDs has revolutionised the treatment of AIIRD. This has led to a marked improvement in quality of life for AIIRD patients, who often now travel for prolonged periods. Many infections are preventable with vaccination. However, as protective immune responses induced by vaccination may be impaired by immunosuppression, where possible, vaccination may need to be performed prior to initiation of immunosuppression. Vaccination status should also be reviewed when planning overseas travel. Limited data regarding vaccine efficacy in patients with AIIRD make prescriptive guidelines difficult. However, a vaccination history should be part of the initial work-up in all AIIRD patients. Those caring for AIIRD patients should regularly consider vaccination to prevent infection within the practicalities of routine clinical practice.
自身免疫性炎性风湿性疾病（AIIRD），如类风湿关节炎、银屑病关节炎和强直性脊柱炎，常并发感染，可导致显著的发病率和死亡率。感染风险增加可能是由于AIIRD的免疫抑制作用、合并症以及使用免疫抑制性传统合成改善病情抗风湿药物（DMARDs），以及最近使用的靶向合成DMARDs和生物DMARDs，这些药物可阻断特定的促炎酶、细胞因子或细胞类型。这些不同DMARDs的使用彻底改变了AIIRD的治疗方式。这使得AIIRD患者的生活质量有了显著提高，他们现在常常能够长时间出行。许多感染可通过接种疫苗预防。然而，由于接种疫苗诱导的保护性免疫反应可能会因免疫抑制而受损，因此在可能的情况下，接种疫苗可能需要在开始免疫抑制之前进行。在计划出国旅行时，也应检查疫苗接种状况。关于AIIRD患者疫苗疗效的数据有限，难以制定规范性指南。然而，接种疫苗史应作为所有AIIRD患者初始检查的一部分。照顾AIIRD患者的人员应在常规临床实践的实际操作范围内，定期考虑接种疫苗以预防感染。
