Dilemma of immunosuppression and infection risk in systemic lupus erythematosus

Abstract

Patients with SLE are at high risk of various infections as evidenced by a number of studies. The main determinants of infection in SLE are disease activity, organ damage, and often inevitable medication. The molecular and cellular mechanisms underlying infection remain unclear. Impaired immunity, immunosuppressants and corticosteroids clearly increase the risk of infection, whereas some medications, such as low-dose IL-2, hydroxychloroquine and IVIG are safe in SLE patients with substantial evidence. It is important to balance the immunosuppression and infection risks in practice. This article focuses on medication-related infections in SLE and discusses the therapeutic options for the disease in clinical practice.

Major Infections of Newly Diagnosed Childhood-Onset Systemic Lupus Erythematosus

“…The reason for a high incidence of infections in the first six months may be due to the uncontrolled immunological abnormalities of the disease, such as lymphopenia, impaired T cell–mediated cytolytic activity, suppressed cytotoxicity of NK cells, abnormal function of B cell subsets, low production of interleukin-2 (IL-2) and etc. 10 …”

Systemic lupus erythematosus Association between Osteomyelitis: A two-sample Mendelian randomization study in European population

“…These drugs modulate cellular and humoral immunity to control SLE by dampening overactive T cells, B cells, and other immune components. However, this suppressive effect on protective immunity concurrently raises infection susceptibility [ 35 ]. Furthermore, the use of immunosuppressive drugs in SLE may contribute to secondary immunodeficiency and further increase the risk of developing OM.…”

Risk factors for initial and recurrent severe infections in first hospitalized patients with systemic lupus erythematosus: A retrospective study of a Chinese cohort

“…Previous studies have investigated the risk and protected factors of severe infection in SLE patients. The increased risk of infection in SLE was associated with disease activity, organ damage, and inevitable medications, including glucocorticoids and immunosuppressants treatment, while hydroxychloroquine use exerted a protective effect on infection 13–15 . Immune system deregulation, manifested by a decrease in T cells, NK cells, and CD4 + T cells, has recently been demonstrated to help differentiate SLE with infection from SLE alone 16 .…”

“…The increased risk of infection in SLE was associated with disease activity, organ damage, and inevitable medications, including glucocorticoids and immunosuppressants treatment, while hydroxychloroquine use exerted a protective effect on infection. [13][14][15] Immune system deregulation, manifested by a decrease in T cells, NK cells, and CD4 + T cells, has recently been demonstrated to help differentiate SLE with infection from SLE alone. 16 History of previous severe infection has also been reported to be one of the strongest factors in predicting severe infection in SLE.…”