Infections in RA Sample Clauses

Infections in RA. Infections are a major problem in RA. The risk factors for infection are largely covered in the previous chapter. This chapter provides some more information on chronic infections that can be an important comorbidity. Viral Hepatitis and Rheumatoid Arthritis Treatment of rheumatoid arthritis in patient with hepatitis B and hepatitis C can present a unique challenge. DMARDs such as leflunomide and methotrexate can cause direct liver injury whilst other immunosuppressants such as glucocorticoids and biologics alter the host’s immune response to the hepatitis infection 203, 204. A prospective study of over five hundred RA patients with evidence of previous hepatitis B infection the risk of hepatoxicity was approx. 3% 203. The risk was the same in those treated with non-biologic DMARDs as those treated with biologics (2.6% vs 2.8%, p=0.87). Of those who developed hepatotoxicity there were no cases of liver failure, hepatic encephalopathy or liver transplant 203. HIV and Rheumatoid Arthritis With improving survival in HIV we are likely to see more patients with coexisting HIV and rheumatoid arthritis. HIV itself can lead to the development of rheumatoid factor and anti- cyclic citrullinated peptide antibodies but usually at low titres of doubtful significance 205. There is insufficient safety data to recommend use of specific DMARDs in RA patients with HIV 205. One of the main concerns in HIV patients is the potential for drug interactions. Ritonavir in particular is a potent inhibitor of the cytochrome P450 3A4 and can dramatically increase the serum concentration of drugs cleared by this pathway including methotrexate and glucocorticoids 206. There are case reports of patients on ritonavir developing cushingoid features following a single intra-articular injection of triamcinolone.
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