Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Front Immunol. 2022 Oct 26;13:1040725. doi: 10.3389/fimmu.2022.1040725. eCollection 2022.
Respiratory tract infections (RTIs) are the most common infections in patients with rheumatic diseases under immunosuppressive treatment and may contribute to morbidity and mortality as well as increased healthcare costs. However, to date only limited data on infection risk in spondyloarthritis (SpA) patients are available. In this study we assessed the occurrence of respiratory tract infections in a monocentric real-world cohort consisting of 330 patients (168 psoriatic arthritis and 162 axial spondyloarthritis patients) and determined factors associated with increased infection risk. Out of 330 SpA patients, 89.3% had suffered from ≥ 1 upper respiratory tract infection (URTI) and 31.1% from ≥ 1 lower respiratory tract infection (LRTI) within the last two years. The most common URTIs were rhinitis and laryngitis/pharyngitis with 87.3% and 36.1%, respectively. Bronchitis constituted the most common LRTI, reported in 29.7% of patients. In a multivariate binomial logistic regression model occurrence of LRTI was associated with chronic lung disease (OR 17.44, p=0.006), glucocorticoid therapy (OR 9.24, p=0.012), previous history of severe airway infections (OR 6.82, p=0.013), and number of previous biological therapies (OR 1.72, p=0.017), whereas HLA B27 positivity was negatively associated (OR 0.29, p=0.025). Female patients reported significantly more LRTIs than male patients (p=0.006) and had a higher rate of antibiotic therapy (p=0.009). There were no significant differences between axSpA and PsA patients regarding infection frequency or antibiotic use. 45.4% of patients had required antibiotics for respiratory tract infections. Antibiotic therapy was associated with smoking (OR 3.40, p=0.008), biological therapy (OR 3.38, p=0.004), sleep quality (OR 1.13, p<0.001) and age (OR 0.96, p=0.030). Hypogammaglobulinemia (IgG<7g/l) was rare (3.4%) in this SpA cohort despite continuous immunomodulatory treatment. Awareness of these risk factors will assist physicians to identify patients with an increased infection risk, who will benefit from additional preventive measures, such as vaccination and smoking cessation or adjustment of DMARD therapy.
呼吸道感染（RTIs）是接受免疫抑制治疗的风湿性疾病患者中最常见的感染，可导致发病率和死亡率增加以及医疗保健费用增加。然而，迄今为止，关于脊柱关节炎（SpA）患者感染风险的数据有限。在这项研究中，我们评估了由 330 名患者（168 名银屑病关节炎和 162 名轴性脊柱关节炎患者）组成的单中心真实世界队列中呼吸道感染的发生情况，并确定了与感染风险增加相关的因素。在 330 名 SpA 患者中，89.3%的患者在过去两年中患有≥1 次上呼吸道感染（URTI），31.1%的患者患有≥1 次下呼吸道感染（LRTI）。最常见的 URTI 是鼻炎和咽炎/扁桃体炎，分别占 87.3%和 36.1%。支气管炎构成最常见的 LRTI，有 29.7%的患者报告。在多变量二项逻辑回归模型中，LRTI 的发生与慢性肺部疾病（OR 17.44，p=0.006）、糖皮质激素治疗（OR 9.24，p=0.012）、严重气道感染史（OR 6.82，p=0.013）和既往生物治疗次数（OR 1.72，p=0.017）有关，而 HLA B27 阳性与 LRTI 呈负相关（OR 0.29，p=0.025）。女性患者报告的 LRTI 明显多于男性患者（p=0.006），抗生素治疗率也较高（p=0.009）。轴性脊柱关节炎和银屑病关节炎患者在感染频率或抗生素使用方面无显著差异。45.4%的患者因呼吸道感染需要使用抗生素。抗生素治疗与吸烟（OR 3.40，p=0.008）、生物治疗（OR 3.38，p=0.004）、睡眠质量（OR 1.13，p<0.001）和年龄（OR 0.96，p=0.030）有关。尽管持续进行免疫调节治疗，但在该 SpA 队列中，低丙种球蛋白血症（IgG<7g/l）很少见（3.4%）。了解这些危险因素将有助于医生识别感染风险增加的患者，这些患者将受益于额外的预防措施，如接种疫苗和戒烟或调整 DMARD 治疗。
