Background For over 10 years, rheumatologists have TNF inhibitors that revolutionized the treatment of various rheumatic and inflammatory disorders. This biotherapy may in some cases give intercurrent infections sources of stopping treatment and reactivation of rheumatic diseases.The objective of this study is to evaluate these characteristics in patients with Spondyloarthritis (SPA) compared to Rhumatoid Arthritis (RA).
Methods Retrospective analysis of 46 Tunisian SPA and 46 Tunisian RA database. SPA and RA patients initiating an anti-TNF (adalimumab (ADA), etanercept (ETA) or infliximab (INF)) or Riuximab (RTX) were identified and followed forward in time. Baseline demographics included disease duration and pain visual analogical scale evaluations (VAS), DAS28 ESR and BASDAI
Results The analyzed cohort comprised patients with average age of begining of 25,65 years (82% male) for SPA group and 42,21 years (78% female) for RA group. The average duration of evolution is of 10,63 years for SPA group and 12,65 years for RA group. 11 cases of SPA group had an HLA B27. 41% for SPA group and 86% for RA group were under disease-modifying antirheumatic drugs (DMARD's) (whose Methotrexate (n=9, SPA/35, RA), and association of Methotrexate and Salazopyrine (n=1, SPA/ 25, RA). The reason for starting biotherapy was therapy failure (n=39, SPA/ 5, RA) and adverse effects (n=2, SPA/ 40, RA). Biotherapy were as follows: INF (n=22, SPA/ 12, RA), ETA (n=18, SPA/ 14, RA), ADA (n=6, SPA/ 3, RA) and RTX (n=17, RA). Adverse effects were noted in 7 cases for SPA group and 12 for RA group, 4 cases (SPA) and 3 cases (RA) of repeatedly urinary infection, 3 cases (SPA) of reactivation of latent tuberculosis, 1 case (SPA) of liver damage, 5 cases (RA) of allergic reaction, 2 cases (RA) of infection of mild parts,1 case (RA) of septic arthritis, 1 case (SPA) of uveitis and in 1 case (RA) a tumor of the ovary. Clinically significant differences in baseline variables were observed between adverse effects in SPA group compared to RA group for the reactivation of latent tuberculosis (Log-rank p=0.002) and for allergic reaction (log-rank p=0.001).
Conclusions The most important adverse effect of TNF inhibitors is infection, which is significantly higher than the non-biologic treatment group. A reactivation of latent tuberculosis is twice times more frequent in patients using biotherapy. Paradoxical reactions do occur during anti-TNF treatment mainly in SPA, such as acute uveitis. Although biotherapy has changed the lives of patients with chronic inflammatory rheumatism, it can bring not only an infection risk, but also a neoplastic risk that requires rapid diagnosis. Only the non-melanoma skin cancer has been registered with TNF inhibitors in RA and SPA. A tumor of the ovary was noted in our study.
Disclosure of Interest None declared
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