M. Baranova, N. Muravyeva, B. Belov
2021 Annals of the Rheumatic Diseases  
Background:Data on the frequency and structure of comorbid infections (CI) in spondyloarthritis (SpA) are few and contradictory.Objectives: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.Methods:The study included 208 patients with SpA (121 men, 87 women, mean age 39.1±12.2 years) who were hospitalized at the V.A. Nasonova Research Institute of Rheumatology. Ankylosing spondylitis
more » ... s diagnosed in 133 patients, psoriatic arthritis - in 57, spondyloarthritis associated with Crohn's disease - in 1, undifferentiated spondyloarthritis - in 17. The majority of respondents had higher education (60.6%). None of the patients consumed alcohol on a daily basis, 124 patients never smoked. The Charlson comorbidity index, equal to 0, had 98 respondents, 1 - 51, 2 - 27, 3 - 15, 4 - 10, 5 or more - 7. Most patients (n=168) received nonsteroidal anti-inflammatory drugs (NSAIDs), as well as glucocorticoids-GC (average duration of administration 239.5±65.8 months), methotrexate-MT (32.4±46.2), sulfasalazine (21.0±32.1), leflunomide (24.0±46.6), biological drugs - TNF-α inhibitors (21.5±23.3), inhibitors of interleukin (iIL)-12/23 (9.0±5.2), iIL-17 (11.0±9.3). Patients were interviewed by a research doctor with the completion of a unified questionnaire, additional data were obtained from medical documentation.Results:Leading in the structure of CI in patients with SpA were respiratory tract infections: acute nasopharyngitis (n=168), tonsillitis (74), acute bronchitis (34), sinusitis (33), pneumonia (29, including 9 cases by the virus SARS-CoV-2), influenza (31), tuberculosis-TB (5, including 2 cases on infliximab therapy, which was the reason for withdrawal of the drug). Infectious diseases of other localization include herpes-viral infections (n=109), mycoses (51), urinary tract infections (47), conjunctivitis and blepharitis (37), otitis (25), genital infections (15), skin infections (14), intestinal infections (13), COVID-19 without lung damage (19), nervous system infections (2), bone infections (2), chronic hepatitis B (1), chronic hepatitis C (1), HIV infection (1), rubella in adulthood (1), measles in adulthood (1). 20.2% of patients reported more frequent development of CI after the onset of the of SpA: 35 of them received immunosuppressive therapy, 7 – monotherapy of NSAIDs. In SpA patients receiving immunosuppressive drugs, there was an increase in the frequency of acute nasopharyngitis (more often 3 times a year), sinusitis, acute bronchitis, pneumonia and herpes-viral infections, in particular herpes zoster. 29.8% of patients reported a more severe course of CI against the background of SpA (12 of them did not receive immunosuppressive drugs). Temporary discontinuation of therapy due to the development of CI occurred in 26.4% of patients. At the same time, in 5 patients treated with GC (including in combination with MT, n=3), the development of furunculosis was the reason for changing the treatment regimen. In one patient, MT therapy was discontinued due to the frequent development of purulent tonsillitis. Exacerbation of SpA after CI was diagnosed in 84 patients (70 of them received immunosuppressive therapy).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.Disclosure of Interests:None declared.
doi:10.1136/annrheumdis-2021-eular.551 fatcat:rek4mzer3rardp32bapijvw6jq