RESUMEN. El factor de necrosis tumoral alfa (TNF-α) es una citocina proinflamatoria fundamental en la respuesta del sistema inmune contra las infecciones, además de participar en la patogénesis inflamatoria de enfermedades crónicas de origen autoinmune. Las terapias biológicas basadas en anticuerpos dirigidos a TNF-α son un valioso recurso en el tratamiento de enfermedades reumáticas. Sin embargo, esto conduce a un aumento en la susceptibilidad a infecciones ante patógenos oportunistas y complicaciones en estos pacientes. Esta revisión tiene como objetivo reportar evidencias acerca de las principales infecciones presentadas tras el uso de terapias anti-TNF-α en pacientes con enfermedades reumáticas, así como las estrategias realizadas ante estos casos.
Approximately 30% of patients with systemic lupus erythematosus (SLE) present steroid resistance (SR). Macrophage migration inhibition factor (MIF) and P-glycoprotein (P-gp) could be related to SR. This work aims to evaluate the relationship between MIF and P-pg serum levels in SR in SLE. Methods: Case–control study including 188 SLE patients who were divided into two groups (90 in the steroid-resistant group and 98 in the steroid-sensitive (SS) group) and 35 healthy controls. MIF and P-gp serum levels were determined by ELISA. Multivariable logistic regression and chi-squared automatic interaction detection (CHAID) were used to explore risk factors for SR. Results: The steroid-resistant group presented higher MIF and P-gp serum levels in comparison with the SS (p < 0.001) and reference (p < 0.001) groups. MIF correlated positively with P-gp (rho = 0.41, p < 0.001). MIF (≥15.75 ng/mL) and P-gp (≥15.22 ng/mL) were a risk factor for SR (OR = 2.29, OR = 5.27). CHAID identified high P-gp as the main risk factor for SR and high MIF as the second risk factor in those patients with low P-gp. Conclusions: An association between MIF and P-gp serum levels was observed in SR. CHAID identified P-gp ≥ 15.22 ng/mL as the main risk factor for SR. More studies are needed to validate these results.
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