阿巴西普治疗类风湿关节炎患者合并播散性组织胞浆菌病 1 例
A Case of Disseminated Histoplasmosis in a Patient with Rheumatoid Arthritis on Abatacept.
机构信息
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.
出版信息
J Gen Intern Med. 2018 May;33(5):769-772. doi: 10.1007/s11606-018-4383-0. Epub 2018 Mar 12.
Biologic agents are effective treatments for rheumatoid arthritis but are associated with important risks, including severe infections. Tumor Necrosis Factor (TNF) α inhibitors are known to increase the risk of systemic fungal infections such as disseminated histoplasmosis. Abatacept is a biologic agent with a mechanism different from that of TNFα inhibitors: It suppresses cellular immunity by competing for the costimulatory signal on antigen-presenting cells. The risk of disseminated histoplasmosis for patients on abatacept is not known. We report a case of abatacept-associated disseminated histoplasmosis and review the known infectious complications of abatacept. While the safety of resuming biologic agents following treatment for disseminated histoplasmosis is also not known, abatacept is recommended over TNFα inhibitors for rheumatoid arthritis patients with a prior serious infection. We discuss the evidence supporting this recommendation and discuss alternative treatments for rheumatoid arthritis patients with a history of a serious infection.
生物制剂是治疗类风湿关节炎的有效方法，但也存在重要风险，包括严重感染。肿瘤坏死因子（TNF）α抑制剂已知会增加全身性真菌感染（如播散性组织胞浆菌病）的风险。阿巴西普是一种与 TNFα 抑制剂作用机制不同的生物制剂：它通过与抗原呈递细胞上的共刺激信号竞争来抑制细胞免疫。阿巴西普治疗患者发生播散性组织胞浆菌病的风险尚不清楚。我们报告了一例与阿巴西普相关的播散性组织胞浆菌病，并回顾了已知的阿巴西普的感染并发症。虽然播散性组织胞浆菌病治疗后恢复使用生物制剂的安全性也未知，但对于先前有严重感染的类风湿关节炎患者，建议使用阿巴西普而非 TNFα 抑制剂。我们讨论了支持这一建议的证据，并讨论了有严重感染史的类风湿关节炎患者的替代治疗方法。
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