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Infections and vasculitis

Thomas, Konstantinos; Vassilopoulos, Dimitrios

Current Opinion in Rheumatology: January 2017 - Volume 29 - Issue 1 - p 17–23
doi: 10.1097/BOR.0000000000000348
VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici
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Purpose of review To review recent evidence for infection rates in patients with systemic vasculitides, the role of specific infectious agents in the pathogenesis of vasculitis and recent breakthroughs in the treatment of virus-associated vasculitides.

Recent findings In well designed recent studies, infections were found to be common during the first 6–12 months in patients with anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) and giant cell arteritis (GCA) and to contribute significantly to increased mortality during this period. New therapeutic schemes with lower cyclophosphamide doses and shorter corticosteroid courses were associated with decreased infectious rates in elderly patients with AAV whereas a prednisone dose greater than 10 mg/day at the end of the first year were associated with increased infectious-related mortality in patients with GCA. Recently, a potential role for varicella zoster virus in GCA pathogenesis has been proposed but more data are needed in order to establish a causal relationship. Finally, preliminary data show excellent short-term efficacy and safety of the new, interferon-free, oral antiviral agents in the treatment of hepatitis C virus-associated cryoglobulinemic vasculitis.

Summary Infections continue to be one of the main causes of mortality in patients with systemic vasculitides, emphasizing the need for safer immunosuppressive therapies and appropriate prophylaxis.

Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece

Correspondence to Dimitrios Vassilopoulos, MD, Associate Professor of Medicine – Rheumatology, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, 114 Vass. Sophias Avenue, 115 27 Athens, Greece. Tel: +30 213 2088516; fax: +30 213 2088399; e-mail: dvassilop@med.uoa.gr

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