Introduction: Despite the therapeutic effectiveness of biologics targeting immune cells or cytokines in patients with inflammatory arthritis, which reflects their pathogenic roles, an increased infection risk is observed in those undergoing biological treatment. However, there are limited data regarding the comparison of infection risks in inflammatory arthritis patients treated with non-biologics (csDMARDs), biologics (bDMARDs), including tumor necrosis factor (TNF) inhibitors and non-TNF inhibitors, or targeted synthetic (ts)DMARDs.

Areas covered: Through a review of English-language literature as of 30 June 2019, we focus on the existing evidence on the risk of infections caused by bacteria, Mycobacterium tuberculosis, and hepatitis virus in inflammatory arthritis patients undergoing treatment with csDMARDs, bDMARDs, or tsDMARDs.

Expert opinion: While the risks of bacterial and mycobacterial infection are increased in arthritis patients treated with csDMARDs, the risks are further higher in those receiving bDMARDs therapy, particularly TNF inhibitors. Regarding HBV infection, antiviral therapy may effectively prevent HBV reactivation in patients receiving bDMARDs, especially rituximab. However, more data are needed to establish effective preventive strategies for HBsAg-negative/HBcAb-positive patients. It seems safe to use cyclosporine and TNF inhibitors in patients with HCV infection, while those undergoing rituximab therapies should be frequently monitored for HCV activity.

Abbreviations: ABT: abatacept; ADA: adalimumab; AS: ankylosing spondylitis; bDMARDs: biologic disease-modifying anti-rheumatic drugs; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; CS: corticosteroids; CsA: cyclosporine A; csDMARDs: conventional synthetic disease-modifying anti-rheumatic drugs; CZP: certolizumab; DAAs: direct-acting antiviral agents; DM: diabetes mellitus; DOT: directly observed therapy; EIN: Emerging Infections Network; ETN: etanercept; GOL: golimumab; GPRD: General Practice Research Database; HBV: hepatitis B virus; HBVr: HBV reactivation; HBsAg+: HBsAg-positive; HBsAg-/anti-HBc+: HBsAg-negative anti-HBc antibodies-positive; HCV: hepatitis C virus; HCQ: hydroxychloroquine: IFX: infliximab; IL-6: interleukin-6; JAK: Janus kinase; LEF: leflunomide; LTBI: latent tuberculosis infection; mAb: monoclonal antibody; MTX: methotrexate; OR: odds ratio; PsA: psoriatic arthritis; PMS: post-marketing surveillance; RA: rheumatoid arthritis; TNF: tumor necrosis factor; TNFi: tumor necrosis factor inhibitor; SCK: secukinumab; SSZ: sulfasalazine; TOZ: tocilizumab; RCT: randomized controlled trial; RR: relative risk; RTX: rituximab; 3HP: 3-month once-weekly isoniazid plus rifapentine; TB: tuberculosis; tsDMARDs: targeted synthetic disease-modifying anti-rheumatic drugs; UTK: ustekinumab; WHO: World Health Organization

简介：尽管针对炎症性关节炎患者的针对免疫细胞或细胞因子的生物制剂具有治疗效果，这反映了它们的致病作用，但在接受生物治疗的患者中观察到感染风险增加。但是，关于用非生物制剂（csDMARD），生物制剂（bDMARD）（包括肿瘤坏死因子（TNF）抑制剂和非TNF抑制剂或靶向合成药物（ts））治疗的炎性关节炎患者感染风险比较的数据有限DMARD。

涵盖地区：通过英语语言文学为6月30日2019年的审查，我们专注于现有的证据由细菌引起的，感染的危险性结核分枝杆菌的炎症性关节炎患者，以及肝炎病毒与csDMARDs，bDMARDs，或接受治疗tsDMARD。

专家意见：虽然在接受csDMARDs治疗的关节炎患者中细菌和分枝杆菌感染的风险增加，但接受bDMARDs治疗的患者（尤其是TNF抑制剂）的风险更高。关于HBV感染，抗病毒治疗可以有效预防接受bDMARDs，尤其是利妥昔单抗的患者的HBV激活。但是，需要更多数据来为HBsAg阴性/ HBcAb阳性患者建立有效的预防策略。在HCV感染的患者中使用环孢菌素和TNF抑制剂似乎是安全的，而接受利妥昔单抗治疗的患者应经常监测HCV活性。

缩略语：ABT：阿巴西普; ADA：阿达木单抗；AS：强直性脊柱炎；bDMARDs：改善生物疾病的抗风湿药；CKD：慢性肾脏疾病；COPD：慢性阻塞性肺疾病；CS：皮质类固醇；CsA：环孢霉素A；csDMARDs：常规的合成疾病改良抗风湿药；CZP：塞妥珠单抗；DAA：直接作用抗病毒药；DM：糖尿病；DOT：直接观察疗法；EIN：新兴感染网络；ETN：依那西普；GOL：戈利木单抗；GPRD：全科医学研究数据库；HBV：乙肝病毒；HBVr：HBV重新激活；HBsAg +：HBsAg阳性；HBsAg- /抗HBc +：HBsAg阴性抗HBc抗体阳性；HCV：丙型肝炎病毒；HCQ：羟氯喹：IFX：英夫利昔单抗；IL-6：白介素6；JAK：Janus激酶；LEF：来氟米特；LTBI：潜伏性结核感染；mAb：单克隆抗体；MTX：甲氨蝶呤 OR：比值比；PsA：银屑病关节炎；PMS：上市后监督；RA：类风湿关节炎；TNF：肿瘤坏死因子；TNFi：肿瘤坏死因子抑制剂；SCK：苏金单抗；SSZ：柳氮磺吡啶；TOZ：托珠单抗；RCT：随机对照试验；RR：相对风险；RTX：利妥昔单抗；3HP：3个月每周一次的异烟肼加利福喷丁；TB：结核；tsDMARDs：靶向合成疾病的抗风湿药；UTK：ustekinumab；世卫组织：世界卫生组织 结核; tsDMARDs：靶向合成疾病的抗风湿药；UTK：ustekinumab；世卫组织：世界卫生组织 结核; tsDMARDs：靶向合成疾病的抗风湿药；UTK：ustekinumab；世卫组织：世界卫生组织