Use of glucocorticoids and risk of infections

Cutolo, Maurizio; Seriolo, Bruno; Pizzorni, Carmen; Secchi, Maria Elena; Soldano, Stefano; Paolino, Sabrina; Montagna, Paola; Sulli, Alberto

doi:10.1016/j.autrev.2008.07.010

Cited by 134 publications

(100 citation statements)

References 18 publications

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“…Prednisolone is often prescribed when there are concerns over infection risk despite itself being well recognised to increase the risk of infections 27,28 . Indeed, there is currently no consensus on DMARD/biologic therapies in patients with RA and co-existent BR and further studies are urgently required, especially given the prevalence rates of up to 30% 3-6 .…”

Section: Discussionmentioning

confidence: 99%

Increased disease activity, severity and autoantibody positivity in rheumatoid arthritis patients with co‐existent bronchiectasis

et al. 2015

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AimPatients with rheumatoid arthritis (RA) and co‐existent bronchiectasis (BRRA) have a five‐fold increased mortality compared to rheumatoid arthritis alone. Yet previous studies have found no difference in clinical and serological markers of RA disease severity between BRRA patients and RA alone. However, RA disease activity measures such as Disease Activity Score of 28 joints – C‐reactive protein (DAS28‐CRP) and anti‐cyclic citrullinated peptide antibodies (anti‐CCP) have not been studied, so we assessed these parameters in patients with BRRA and RA alone.MethodsBRRA patients (n = 53) had high‐resolution computed tomography proven bronchiectasis without any interstitial lung disease and ≥ 2 respiratory infections/year. RA alone patients (n = 50) had no clinical or radiological evidence of lung disease. DAS28‐CRP, rheumatoid factor (immunoglobulin M) and anti‐CCP were measured in all patients, together with detailed clinical and radiology records.ResultsIn BRRA, bronchiectasis predated RA in 58% of patients. BRRA patients had higher DAS28 scores (3.51 vs. 2.59), higher levels of anti‐CCP (89% vs. 46%) and rheumatoid factor (79% vs. 52%) (P = 0.003) compared to RA alone. Where hand and foot radiology findings were recorded, 29/37 BRRA (78%) and 13/30 (43%) RA alone had evidence of erosive change (P = 0.003). There were no significant differences between groups in smoking history or disease‐modifying anti‐rheumatic drug/biologic therapy.ConclusionsIncreased levels of RA disease activity, severity and RA autoantibodies are demonstrated in patients with RA and co‐existent bronchiectasis compared to patients with RA alone, despite lower tobacco exposure. This study demonstrates that BRRA is a more severe systemic disease than RA alone.

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Section: Discussionmentioning

confidence: 99%

Increased disease activity, severity and autoantibody positivity in rheumatoid arthritis patients with co‐existent bronchiectasis

et al. 2015

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“…When she was readmitted for multiple opportunistic infections, she was treated with 15 mg prednisolone daily, and the cumulative dose reached 1,315 mg in addition to 1,500 mg methylprednisolone at the initiation of the therapy. A daily dose of 15 mg prednisolone is not believed to cause severe immunosuppression [5,6]. The cumulative dose including pulse therapy, however, may increase the risk of infection about 2-to 4-fold [5,11].…”

Section: Discussionmentioning

confidence: 99%

“…Use of glucocorticoids increases the risk of viral, bacterial, fungal, and parasitic infections in various organs, and the risk of infection depends on the dose and duration of treatment [5,6]. However, it is rare for multiple opportunistic infections in digestive tract to occur in a human immunodeficiency virus (HIV)-negative and nontransplant patient during treatment with glucocorticoids alone [7].…”

Section: Introductionmentioning

confidence: 99%

AP-VAS 2012 case report: a case of ANCA-negative crescentic glomerulonephritis complicating multiple opportunistic infections in the digestive tract

et al. 2013

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Crescentic glomerulonephritis (GN) is one of the common causes of rapidly progressive glomerulonephritis (RPGN). Pauci-immune crescentic GN is usually associated with anti-neutrophil cytoplasmic antibody (ANCA). However, patients with pauci-immune crescentic GN who lack ANCAs have recently been reported. Approximately 10-30 % of patients with pauci-immune crescentic GN lack ANCAs. The clinical characteristics of patients with ANCA-negative pauci-immune crescentic GN are not entirely the same as patients with ANCApositive GN, and this suggests that ANCA-negative and ANCA-positive pauci-immune crescentic GN might be different disease entities. We report a patient with ANCAnegative crescentic GN complicated with multiple opportunistic infections (Candida albicans, herpes simplex virus, and Cytomegalovirus) in the digestive tract during the course of immunosuppressive therapy. After antifungal and antiviral therapies including itraconazole, valaciclovir, and ganciclovir, she recovered from multiple opportunistic infections. The occurrence of comorbid opportunistic infections during the course of immunosuppressive therapy may not be rare in the elderly. However, a case of multiple opportunistic infections limited to the digestive tract is very rare.

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“…High endogenous GC secretion (hypersecretion), as well as high exogenous GC doses have been associated with lung infections and opportunistic fungal infections [106]. In a nested case-controlled analysis using data from a Canadian administrative database, a 2011 publication [107] reported that there was a dose response in the prevalence of serious infection in older patients with RA according to GC use (cumulative dose weighted by the closeness in time to the index date, i.e.…”

Section: Adverse Effects Of Gcs On the Immune Systemmentioning

confidence: 99%

Balancing benefits and risks of glucocorticoids in rheumatic diseases and other inflammatory joint disorders: new insights from emerging data. An expert consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

et al. 2016

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Purpose This consensus review article considers the question of whether glucocorticoid (GC) therapy is still relevant in the treatment of rheumatic diseases, with a particular focus on rheumatoid arthritis (RA), and whether its side effects can be adequately managed. Recent basic and clinical research on the molecular, cellular and clinical effects of GCs have considerably advanced our knowledge in this field. An overview of the subject seems appropriate.

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Use of glucocorticoids and risk of infections

Cited by 134 publications

References 18 publications

Increased disease activity, severity and autoantibody positivity in rheumatoid arthritis patients with co‐existent bronchiectasis

Increased disease activity, severity and autoantibody positivity in rheumatoid arthritis patients with co‐existent bronchiectasis

AP-VAS 2012 case report: a case of ANCA-negative crescentic glomerulonephritis complicating multiple opportunistic infections in the digestive tract

Balancing benefits and risks of glucocorticoids in rheumatic diseases and other inflammatory joint disorders: new insights from emerging data. An expert consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)

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