PMC:7102591 / 7207-10150 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7102591","sourcedb":"PMC","sourceid":"7102591","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7102591","text":"3 Is the risk of viral infection increased in RA patients?\nThe relationship between RA and infectious diseases is very complex and can be interpreted in two different directions. On the one hand, in fact, the potential role of external microorganisms in producing acute and chronic arthritis in the form of either the direct colonization of the joints by the pathogen or the aberrant autoimmune reaction produced by the host response to the infection is well known [23,24]. Few studies have investigated a potential link between respiratory viral infections and the development of RA [25] and in particular a Korean study reported parainfluenza and coronavirus to be associated with the number of incident RA [26]. In addition, in patients with overt inflammatory arthritis, infections are a major concern as they can contribute to disease flares [[27], [28], [29]]. On the other hand, RA patients carry a documented increased risk of infection compared with the general population. A population-based study by Doran and colleagues compared two matched groups of 609 patients with or without RA showing that RA patients had a significantly higher risk of serious (RR 1.53, 95% CI 1.41–1.65) and hospitalized (RR 1.88, 95% CI 1.71–2.07) infections [30]. Similarly, a prospective cohort study conducted on 2108 patients with inflammatory polyarthritis reported a 2- to 4-fold increased risk of hospitalized infection compared to healthy population [31]. This trend is primarily the result of a general impairment of the immune system typical of all autoimmune disorders and strictly dependent on the degree of disease activity. In fact, it has been demonstrated by an analysis conducted in 16,242 RA patients from the US CORRONA registry that each 0.6 unit increase in Disease Activity Score 28 (DAS28) corresponded to a 25% increased rate of infections requiring hospitalization (Incident rate ratio [IRR] 1.25, p = .03) and a 4% increased rate of outpatient infections (IRR 1.04, p = .01) [32]. In addition, a subsequent report from the same registry showed that the risk of serious infections increased progressively from patients achieving clinical remission to those achieving low (adjusted IRR 1.69, 95% CI 1.32–2.15) or moderate (adjusted IRR 1.30, 95% CI 1.09–1.56) disease activity, demonstrating the importance of maintaining a good disease control in order to reduce infectious complications [33].\nAnother important determinant of infectious risk is the presence of comorbidities, which very often complicate the course of RA [34]. Diabetes mellitus, cardiovascular diseases, renal failure, interstitial lung disease, and chronic obstructive pulmonary disease (COPD) are all concomitant disorders associated with an increased incidence of infections in RA [27,35].\nFinally, RA can also be complicated by infections caused by the iatrogenic effect of immunosuppressive therapies, which will be discussed in detail in the next 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