Listeria monocytogenes infection in patients with rheumatic diseases on TNF-alpha antagonist therapy: the Spanish Study Group experience.

OBJECTIVE: The prognosis of patients with rheumatic diseases has improved considerably following the use of biological therapies. However, an increase in the frequency of bacterial infections has been observed in patients receiving these therapies. In the present study we aimed to assess the frequency of Listeria monocytogenes infection in a large series of patients with rheumatic diseases on treatment with tumor necrosis factor (TNF)-alpha blockers because of active disease refractory to conventional therapy, included in the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases (BIOBADASER) of the Spanish Society for Rheumatology. METHODS: Assessment of the incidence of infection due to Listeria monocytogenes in the Spanish Registry Study (BIOBADASER) per 1000 patient-years and 95% confidence intervals (95% CIs) was performed. Rate from this registry was compared with that from the general population in Europe and with the rate found in patients with rheumatoid arthritis (RA) from the Spanish Rheumatoid Arthritis Registry Cohort Study (EMECAR) that assessed morbidity and clinical expression of RA and included patients treated in most cases with conventional therapies. RESULTS: Six patients on treatment with TNF-alpha antagonists were diagnosed as having Listeria monocytogenes infection. The incidence of this infection per 1000 patient-year (95% CI) was 0.256 (95% CI: 0.115-0.570). This was greater than the incidence observed in the general population from Europe and in the EMECAR study. CONCLUSION: Despite the benefits associated to the use of TNF-alpha antagonists, a high level of surveillance is required to reduce the potential risk of infections related to the use of these drugs.

Terapias hormonales, fertilidad y embarazo en el síndrome Antifosfolipídico / Hormone therapy, fertility and pregnancy in antiphospholipid syndrome

Debido al riesgo trombótico, y a sus implicaciones en la fertilidad, el síndrome antifosfolipídico (SAF) conlleva consideraciones particulares respecto a cualquier tipo de terapia hormonal y a la gestación. En el presente artículo, se procede a revisar ampliamente todos estos aspectos. Se desglosa lo referente a anticoncepción, terapia hormonal sustitutiva y moduladores selectivos de los receptores de estrógenos en el SAF. Se revisa la fertilización in vitro/transferencia embrionaria y la inducción ovárica en estas pacientes. Por último, se detallan las posibles complicaciones fetales y maternas durante la gestación, y basándose en la bibliografía, se indica una posible guía para el manejo del embarazo en mujeres con SAF(AU)

Antiphospholipid syndrome (APS) carries a risk of thrombosis and infertility. Consequently the use of any type of hormone therapy and pregnancy in APS requires special considerations. The present article provides a broad review of all these issues. The use of contraception, hormone replacement therapy and selective estrogen receptor modulators in APS are described. In vitro fertilization/embryo transfer and ovarian induction in these patients are reviewed. Lastly, the possible fetal and maternal complications that can occur during pregnancy are described and, based on the literature, recommendations for the management of pregnancy inwomen with APS are provided(AU)

[Hormone therapy, fertility and pregnancy in antiphospholipid syndrome]. / Terapias hormonales, fertilidad y embarazo en el síndrome antifosfolipídico.

Antiphospholipid syndrome (APS) carries a risk of thrombosis and infertility. Consequently the use of any type of hormone therapy and pregnancy in APS requires special considerations. The present article provides a broad review of all these issues. The use of contraception, hormone replacement therapy and selective estrogen receptor modulators in APS are described. In vitro fertilization/embryo transfer and ovarian induction in these patients are reviewed. Lastly, the possible fetal and maternal complications that can occur during pregnancy are described and, based on the literature, recommendations for the management of pregnancy in women with APS are provided.