Toxoplasma gondii seroprevalence in rheumatoid arthritis patients treated with biological agents

Abstract

Aim: Toxoplasma gondii infection appears to be asymptomatic in most of the patients but its mortality rate is high in immunocompromised patients and in those taking immunosuppressive drugs, when reactivated and untreated. Severe infections are well-known to occur in rheumatoid arthritis (RA) patients treated with immunosuppressive drugs such as tumor necrosis factor alpha antagonist. TNF-alpha is essential for granuloma formations, which are important for the defense against intracellular pathogens and the process. It seems it is inevitable that anti-TNF agents being used in RA disease treatment are going to create an incline towards all kind of infections, especially tuberculosis and other granulomatous infections (toxoplasmosis, histoplasmosis, etc.). We investigated the T. gondii seroprevalence in RA patients treated with biologic agents and disease modifying anti-rheumatic drugs, systemic lupus erythematosus patients treated with immunosuppressive drug combinations and compared them with healthy controls.

Methods: In this study we investigated the T. gondii seroprevalence in 33 rheumatoid arthritis (RA) patients treated with biologic agents, 26 RA patients treated with disease modifying anti-rheumatic drugs (DMARD), 15 Systemic lupus erythematosus (SLE) patients treated with immunosuppressive drug combinations and in 19 healthy controls.

Results: Toxoplasma IgM enzyme linked immunosorbent (ELISA) assay was negative for all groups. Whereas 29 (87.9%) of rheumatoid arthritis patients treated by the biologic agents, 21(80.8%) of rheumatoid arthritis patients treated by disease modifying antirheumatic drugs, 15 (100%) of Systemic lupus erythematosus patients and 4 (21.1%) of the controls were seropositive for Toxoplasma Ig G. 

Conclusion: During the immunosuppressive treatment the risk of toxoplasma infection should be taken into consideration.

Keywords

• Toxoplasma gondii,Rheumatoid arthritis,Biological agents

Biyolojik ajanlarla tedavi edilen romatoid artritli hastalarda Toxoplasma gondii seroprevalansı

Öz

Amaç: Toxoplasma gondii enfeksiyonu çoğu hastada asemptomatik seyreder; ancak immun yetmezliği olan ve immunsupresif ilaç alan hastalarda nüks durumunda veya tedavi edilmediğinde mortalite oranı yüksektir. Romatoid artritli (RA) hastaların tümor nekrozis faktör alfa (TNF-alfa) antagonisti gibi immunsupresif ilaçlarla tedavi edildiğinde ciddi enfeksiyonlar gelişebileceği bilinmektedir. TNF-alfa romatoid artrit patogenezindeki önemi ile birlikte diğer inflamatuvar cevaplar ve immün sistemin enfeksiyonlarla mücadelesinde etkin rol oynayan önemli bir sitokindir.TNF alfa özellikle hücre içi patojenlere karşı savunmada önemli olan granülamatöz oluşumlar ve idame sürecinde çok önemlidir.Bu nedenle RA tedavisinde yaygın olarak kullanılan anti-TNF ajanların başta tüberküloz ve benzeri (toksoplazmozis,histoplazmozis vb.) granülomatöz enfeksiyonlar olmak üzere her türlü enfeksiyona karşı yatkınlık oluşturması kaçınılmaz görünmektedir.

Yöntemler: Bu çalışmada biyolojik ajanla tedavi edilen 33 romatoid artritli (RA), hastalığı modifiye edici ajanla tedavi edilen 26 RA’li, immunsupresif ilaç kombinasyonları ile tedavi edilen 15 sistemik lupus eritematozuslu (SLE) hasta ve 19 sağlıklı kontrolde enzim linked immunosorbent assay yöntemi ile Toxoplasma gondii seroprevelansı incelenmiştir. 

Bulgular: Toxoplasma IgM düzeyleri ELISA yöntemi ile tüm gruplarda negatifti. Ancak biyolojik ajanla tedavi edilen 29 (%87.9) RA’li, hastalığı modifiye edici ajanla tedavi edilen 21(%80.8) RA’li ve 15 (%100) SLE’li hastada ve kontrol grubunda 4 (%21.1) kişide Toxoplasma Ig G seropozitifti. 

Sonuç: Immun supresif tedavi sırasında hastalarda toxoplasma enfeksiyonu riski göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Toxoplasma gondii,Romatoid artrit,Biyolojik ajanlar

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