aDivision of Rheumatology, Ochsner Clinic Foundation, New Orleans, LA, USA hSection of Rheumatology, Louisiana State University Health Sciences Center,
New Orleans, LA, USA cDepartment of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
Chronic inflammatory diseases lead to disabling destruction of joints, end-stage organ damage, hematologic derangements, and neurologic compromise. The introduction of biologic agents has produced an astounding transformation by halting or slowing the progression of diseases, such as rheumatoid arthritis (RA), psoriatic arthritis, spondyloarthropathy, collagen vascular disease, inflammatory bowel disease, and multiple sclerosis resulting in marked decrease of disability and improvement in quality of life and health outcomes.
Along with great relief and hope, biologics have brought the need for expert vigilance requiring judicious selection of candidates, close observation, and careful attention to patient education. Biologics are associated with the development of serious life-threatening infections in addition to other well-documented hematologic, immunologic, cardiovascular, and malignant adverse effects. Further complications include the concomitant use of other immunosuppressive therapies, such as prednisone and methotrexate; coexistent morbidities ; and underlying immune dysfunction associated with autoimmune diseases . This article focuses on biologics in current and imminent use, predominantly tumor necrosis factor (TNF)-a inhibitors, to provide a reference and gateway to prevention, recognition, and management of potential pathogens of serious infections defined as fatal,
This article is dedicated in sadness and hope to the history, excellence of care, and remarkable medical training provided by West-900-Infectious Disease Unit of Charity Hospital, New Orleans, Louisiana.
* Corresponding author. 618 Robert Street, New Orleans, LA 70115. E-mail address: [email protected] (L.A. Saketkoo).
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