Infections ostéoarticulaires et traitements ciblés des rhumatismes inflammatoires

Patients with chronic inflammatory rheumatic disorders may present an increased risk of osteoarticular infection related to age, comorbidities, previous intra-articular corticosteroid injection, surgical procedures or the use of immunosuppressive drugs including corticosteroids or targeted therapies. Data regarding the risk of osteoarticular infection remain scarce and mainly restricted to TNF-α inhibitors. Although an increased risk of osteoarticular infection in native or prosthetic joints of patients receiving targeted biological therapies has been reported in various national and international registries, it appears to be moderate, lower than respiratory, skin, and urinary infections. The risk of osteoarticular infection also remains stable over time, similar to what was described before the era of biologic therapies. Moreover, this risk must be balanced against that of corticosteroids, which are often necessary to control flare-ups induced by the suspension of the biological agent. Staphylococcus aureus remains the most frequently observed microorganism, but certain species usually barely involved in osteoarticular infections should be assessed in these patients. Osteoarticular infection in patients receiving targeted therapies should not be ruled out in absence of fever and/or elevation of acute phase reactants. Several questions need to be addressed, including the weight of targeted therapies in the increased risk of osteoarticular infection compared to other risk factors, in particular age, the underlying rheumatic disease or corticosteroid therapy.