Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-α therapy

Objective. With rising numbers of anti-tumour necrosis factor alpha (TNF-alpha) treatments for rheumatoid arthritis (RA), Crohn's disease and other conditions, physicians unaware of potential pitfalls are increasingly likely to encounter associated severe infections. Our purpose was to assess the incidence and nature of severe infections in our RA patients under anti-TNF-alpha therapy. Methods. We reviewed patient charts and records of the Infectious Disease Unit for serious infections in patients with RA in the 2 yr preceding anti-TNF-alpha therapy and during therapy. Results. Serious infections affected 18.3% of patients treated with infliximab or etanercept. The incidence was 0.181 per anti-TNF-alpha treatment year vs 0.008 in the 2 yr preceding anti-TNF-alpha therapy. In several cases, only a few signs or symptoms indicated the severity of developing infections, including sepsis. Conclusions. A high level of suspicion of infection is necessary in patients under anti-TNF-alpha therapy. We suggest additional strategies for the prevention, rapid identification and pre-emptive therapy of such infections.