gms | German Medical Science

Introduction: Patients with rheumatoid arthritis (RA) are at high risk of developing comorbid infections (CI), which is due to both the autoimmune process itself and the need to use immunosuppressive drugs. The aim of the study was to study the frequency and structure of CI, as well as the vaccination status in RA patients undergoing inpatient treatment at the V.A. Nasonova Research Institute of Rheumatology in the course of a one-moment retrospective study.

Methods: The study included 161 RA patients: 132 women, 29 men. The age of patients is 52.0±14.0 years, the duration of the disease is 9.9±9.3 years. In most patients, RA activity was high (59.7%) or moderate (36.2%). 69% of patients received glucocorticoids (duration of administration 60.1±79.7 months, cumulative dose 21.6±76.0 g in terms of prednisolone), 92.7% - methotrexate-MT (average dose 19 mg per week, duration of administration 53.3±61.7 months), 45% - leflunomide (duration of administration 40.0±38.0 months), 31% - biological drugs (etanercept - 19, rituximab - 19, abatacept - 6, adalimumab – 5, sarilumab - 3, infliximab - 2, certolizumab pegol - 2, tocilizumab – 2, golimumab – 1, secukinumab - 1), 29.1% - hydroxychloroquine, 20% - sulfasalazine. Patients were interviewed by a research doctor with the completion of a unified questionnaire, additional data were obtained from medical documentation.

Results: 38.3% of patients reported an increase in the frequency of CI after the onset of RA. For the first time, 241 cases of CI were diagnosed: mycoses of the skin and mucous membranes - 53, herpes-viral infections - 51 (including 28 - herpes zoster, 1 - genital herpes), pneumonia - 35 (including pneumonia caused by the virus SARS-CoV2 – 11), urinary system infections - 32,), tonsillitis - 23, acute bronchitis - 14, otitis – 11, sinusitis – 10, infections of the skin and subcutaneous fat - 8, purulent arthritis - 1, hepatitis A – 1, adnexitis - 1. In addition, 55 patients reported that they became more likely to suffer from acute nasopharyngitis. 60% of patients had a more severe course of previously observed CI. Temporary discontinuation of antirheumatic therapy due to CI occurred in 51% of patients. In 16% of patients, due to the increase in the frequency of CI, the treatment regimen for RA was changed. Exacerbation of RA after CI was observed in 67.1% of patients. CI was most common in patients treated with TNF-ɑ inhibitors, rituximab, MT. A study of the vaccination status showed that only 22 patients were vaccinated against influenza (20) and/or pneumococcal infection (5).

Conclusion: The problem of CI in RA still remains important. Vaccination coverage of RA patients remains unsatisfactory. Further studies are needed on large samples of RA patients in order to study the prevalence of CI depending on the therapy, including in vaccinated patients.

Disclosures: None declared