Comorbid infections in spondyloarthritis: a modern view of the problem

Intoduction. Currently, for the treatment of patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA), basic anti-inflammatory drugs and biological drugs are widely used to effectively control the activity of the disease. However, the use of these drugs is associated with an increased risk of developing comorbid infections, some of which can be prevented by vaccination. Objective. To evaluate the immunogenicity, safety, and clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with RA and SpA.Materials and methods. The study included 122 patients: 79 - with RA, 43-with SpA. Most patients had a history of two or more cases of lower respiratory tract infections, 2 patients reported a monthly exacerbation of chronic sinusitis, one patient reported the development of otitis media every 2-3 months. At the time of inclusion in the study, most patients received immunosuppressive therapy. PPV-23 was administered in an amount of 1 dose (0.5 ml) subcutaneously against the background of anti-rheumatic therapy. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clin-ical Diagnostics s.r.o., Czech Republic) before vaccination, 1, 3 and 12 months after vaccination. In addition, the tolerance of PPV-23, the frequency of pneumonia, and the effect on the activity of RA and SpA were evaluated (according to the dynamics of DAS28 and BASDAI).Results. At 1, 3, and 12 months after vaccination, the concentration of antibodies to pneumococcal capsular polysaccharide was significantly higher than the baseline values, which indicates sufficient immunogenicity of PPV-23. There was no negative effect of vaccination on the activity of the underlying disease and the occurrence of new autoimmune disorders. In the majority of patients (67% - RA, 81.4% - SpA), the tolerance of the vaccine was good. During the follow-up period, none of the patients developed pneumonia. Patients suffering from frequent sinusitis and otitis media reported the absence of these infections after vaccination.Conclusion. Preliminary results of the study indicate sufficient immunogenicity, safety, and clinical efficacy of PPV-23 in patients with RA and SpA.

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Immunogenicity, safety and efficacy of 23-valent pneumococcal polysaccharide vaccine in patients with inflammatory joint diseases (preliminary data)

Baranova

Сергеева

Муравьева

et al. 2021

Medicinskij sovet

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The frequency and structure of comorbid infections in patients with spondyloarthritis (preliminary own data)

2021

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Introduction. Data on the frequency of comorbid infections (CI) in patients with spondyloarthritis (SpA) are few and contradictory. Objective. The aim of the study was to study the frequency and structure of CI in the inpatient population of SpA patients in the course of a one-moment retrospective study.Subjects and methods. The study included 205 patients with SPA: 119 men, 86 women, the age of patients was 39.02 ± 12.2 years, the duration of the disease was 129.3 ± 104.3 months. Ankylosing spondylitis was diagnosed in 133 patients, psoriatic arthritis in 55, spondyloarthritis associated with Crohn’s disease – in 1, undifferentiated spondyloarthritis – in 16. Most patients, along with nonsteroidal anti-inflammatory drugs, received glucocorticoids, basic anti-inflammatory drugs, and biological drugs. Patients were interviewed by a research doctor with the completion of a unified questionnaire, additional data were obtained from medical documentation.Results. 20% of patients reported more frequent CI development after the SpA debut. 28.7% of patients reported a more severe course of previously observed CI. Temporary discontinuation of therapy due to the development of CI occurred in 25.4% of patients. Exacerbation of SpA after CI was diagnosed in 40% of patients. In general, the leading place in the structure of CI was occupied by infections of the respiratory tract and ENT-organs, the second place belonged to herpes-viral infections. Serious CI accounted for 6.8% of all cases of CI. In SpA patients receiving immunosuppressive therapy, there was an increase in the frequency of acute nasopharyngitis, sinusitis, acute bronchitis, pneumonia and herpes-viral infections. However, cases of CI have also been reported in patients who have never received immuno-suppressive drugs.Conclusion. The data obtained indicate the important of the problem of CI in SpA. Further studies are needed on large samples of patients in order to find significant risk factors for CI, study their relationship with clinical characteristics and influence on the course of SpA.

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Immunogenicity, Safety, and Clinical Eﬀectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Patients With Spondyloarthritis (Preliminary Data)

Baranova¹,

Muravyeva²,

Белов³

et al. 2022

A&Ch

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Background. Immunosuppressive drugs are widely used for the treatment of patients with spondyloarthritis (SpA) to eﬀectively control the activity of the disease. At the same time, the use of these drugs is associated with an increased risk of developing infections of the upper and lower respiratory tract, which can be prevented by vaccination. The aim of the study was to evaluate the immunogenicity, safety, and clinical eﬃcacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with SpA. Material and methods. The study included 54 patients with SpA: 39 with ankylosing spondylitis, and 15 with psoriatic arthritis. Most patients had a history of two or more cases of lower respiratory tract infections, 2 patients reported a monthly exacerbation of chronic sinusitis, one patient reported the development of otitis every 2–3 months. 72% of patients received immunosuppressive therapy at the time of inclusion in the study. PPV-23 was administered in the amount of 1 dose (0.5 ml) against the background of ongoing antirheumatic therapy. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics s.r.o., Czech Republic) at baseline, after 1, 3, and 12 months after vaccination. The tolerability of PPV-23, the eﬀect of vaccination on SpA activity (according to the dynamics of the BASDAI index), and the incidence of upper and lower respiratory tract infections were assessed. Results. The concentration of antibodies to pneumococcal capsular polysaccharide was signiﬁcantly higher 1, 3, and 12 months after vaccination compared to baseline. There was no negative eﬀect of vaccination on the activity of SpA and the emergence of «new» autoimmune disorders. The vaccine was well tolerated by 76% of patients., Only one patient developed pneumonia during the observation period. Patients suﬀering from frequent sinusitis and otitis reported the absence of these infections after vaccination. Conclusions. Preliminary results of the study indicate suﬃcient immunogenicity, safety, and clinical eﬃcacy of PPV-23 in patients with SpA.

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Comorbid infections in spondyloarthritis: a modern view of the problem

Cited by 4 publications

References 55 publications

Immunogenicity, safety and efficacy of 23-valent pneumococcal polysaccharide vaccine in patients with inflammatory joint diseases (preliminary data)

Immunogenicity, safety and efficacy of 23-valent pneumococcal polysaccharide vaccine in patients with inflammatory joint diseases (preliminary data)

The frequency and structure of comorbid infections in patients with spondyloarthritis (preliminary own data)

Immunogenicity, Safety, and Clinical Eﬀectiveness of the 23-Valent Pneumococcal Polysaccharide Vaccine in Patients With Spondyloarthritis (Preliminary Data)

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