ABSTRACT
Chronic viral infections in rheumatic patients are a diagnostic and therapeutic challenge. Some of the disease-modifying antirheumatic drugs (DMARD) commonly used in rheumatoid arthritis, such as methotrexate and leflunomide, are hepatotoxic. With biological therapy, which is now widely used in patients refractory to these and other DMARD, some cases of reactivation of hepatitis B, even fulminant cases, have been reported, especially when employing TNF antagonists and rituximab, so their use must be carefully assessed and usually accompanied by antiviral therapy. However, there have not been reports of reactivation of hepatitis C after immunosuppressive therapy. In patients with HIV infection, administration of immunosuppressive therapy carries a high risk of opportunistic infections, although the new highly active antiviral therapy allows the use of some drugs in selected cases.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , HIV Infections/complications , Hepatitis B, Chronic/complications , Hepatitis C, Chronic/complications , Immunosuppressive Agents/therapeutic use , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/complications , Chemical and Drug Induced Liver Injury , HIV Infections/immunology , Hepatitis B, Chronic/immunology , Hepatitis C, Chronic/immunology , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Isoxazoles/adverse effects , Isoxazoles/therapeutic use , Leflunomide , Methotrexate/adverse effects , Methotrexate/therapeutic use , Practice Guidelines as Topic , Rituximab , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
Las infecciones virales crónicas en un paciente reumático constituyen un reto diagnóstico y terapéutico. Algunos de los fármacos antirreumáticos modificadores de la enfermedad (FAME) más utilizados en la artritis reumatoide, como el metotrexato y la leflunomida, presentan riesgo de hepatotoxicidad. Con la terapia biológica, que es hoy en día ampliamente utilizada en pacientes refractarios a estos y otros FAME, se han descrito casos de reactivación de hepatitis B, incluso fulminante, especialmente con los antagonistas del TNF y rituximab, por lo que su utilización ha de ser cuidadosamente valorada y, generalmente, administrada junto con tratamiento antiviral. Sin embargo, no se han descrito casos de reactivación de hepatitis C tras terapia inmunosupresora. En los pacientes con serología VIH la administración de tratamiento inmunosupresor conlleva un elevado riesgo de infecciones oportunistas, aunque la nueva terapia antiviral altamente activa permite utilizar algunos fármacos en casos seleccionados (AU)
Chronic viral infections in rheumatic patients are a diagnostic and therapeutic challenge. Some of the disease-modifying antirheumatic drugs (DMARD) commonly used in rheumatoid arthritis, such as methotrexate and leflunomide, are hepatotoxic. With biological therapy, which is now widely used in patients refractory to these and other DMARD, some cases of reactivation of hepatitis B, even fulminant cases, have been reported, especially when employing TNF antagonists and rituximab, so their use must be carefully assessed and usually accompanied by antiviral therapy. However, there have not been reports of reactivation of hepatitis C after immunosuppressive therapy. In patients with HIV infection, administration of immunosuppressive therapy carries a high risk of opportunistic infections, although the new highly active antiviral therapy allows the use of some drugs in selected cases (AU)
Subject(s)
Humans , Male , Female , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Hepatitis B/complications , Hepatitis B/diagnosis , Hepatitis C/complications , Hepatitis C/diagnosis , Immunologic Deficiency Syndromes/complications , Immunologic Deficiency Syndromes/diagnosis , Biological Therapy , Opportunistic Infections/complications , Opportunistic Infections/diagnosis , Opportunistic Infections/therapy , AIDS-Related Opportunistic Infections/complicationsABSTRACT
Objetivo Servir de referencia para reumatólogos e implicados en el tratamiento de la artritis reumatoide que vayan a utilizar o consideren la utilización de terapias biológicas en su manejo. Métodos Las recomendaciones se emitieron siguiendo la metodología de grupos nominales y basadas en revisiones sistemáticas. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford y el grado de acuerdo se extrajo por técnica Delphi. Resultados Se realizan recomendaciones sobre el uso de los siete agentes biológicos disponibles para la artritis reumatoide en la actualidad en nuestro país. El objetivo del tratamiento es lograr la remisión de la enfermedad lo más precozmente posible. Se revisan las indicaciones y matizaciones del uso de terapias biológicas y cuál debe ser la evaluación previa y la vigilancia del paciente con estos fármacos. Conclusiones Se presentan las actualizaciones a las recomendaciones SER para el uso de terapias biológicas en pacientes con artritis reumatoide(AU)
Objective To provide a reference to rheumatologists and to those involved in the treatment of RA who are using, or about to use biologic therapy. Methods Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Results We have produced recommendations on the use of the seven biologic agents available for RA in our country. The objective of treatment is to achieve the remission of the disease as quickly as possible. Indications and nuances regarding the use of biologic therapy were reviewed as well as the evaluation that should be performed prior to administration and the follow up of patients undergoing this therapy. Conclusions We present an update on the SER recommendations for the use of biologic therapy in patients with RA(AU)
Subject(s)
Humans , Arthritis, Rheumatoid/drug therapy , Biological Therapy , Consensus , Guidelines as Topic , Evidence-Based Medicine , Antirheumatic Agents/therapeutic use , Tumor Necrosis Factors/antagonists & inhibitors , Antibodies, Monoclonal/therapeutic use , Interleukin-1/antagonists & inhibitorsABSTRACT
OBJECTIVE: To provide a reference to rheumatologists and to those involved in the treatment of RA who are using, or about to use biologic therapy. METHODS: Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. RESULTS: We have produced recommendations on the use of the seven biologic agents available for RA in our country. The objective of treatment is to achieve the remission of the disease as quickly as possible. Indications and nuances regarding the use of biologic therapy were reviewed as well as the evaluation that should be performed prior to administration and the follow up of patients undergoing this therapy. CONCLUSIONS: We present an update on the SER recommendations for the use of biologic therapy in patients with RA.
ABSTRACT
No disponible
Subject(s)
Humans , Arthritis, Rheumatoid/epidemiology , Antirheumatic Agents/therapeutic use , Biological Therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Tumor Necrosis Factors/antagonists & inhibitorsABSTRACT
No disponible
Subject(s)
Humans , Spondylitis, Ankylosing/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic useABSTRACT
No disponible