Respiratory Infections in the Rheumatic Patients: Epidemiology, Pathogenesis, Prophylaxis and Management

Pulmonary infections are an important consideration in the management of patients with rheumatological diseases, especially in those with associated lung disease. Underlying altered immune status and administration of immunomodulatory drugs are thought to be the primary drivers of increased susceptibility to infection. Multiple studies have suggested that rheumatic patients, especially those taking biologic agents such as tumor necrosis factor-alpha (TNF-α) inhibitors, are at an increased risk of infection. Clinicians can attenuate the risk of serious infections by ensuring appropriate vaccination and by screening patients carefully for opportunistic infections prior to initiating therapy with biologic agents. Any signs or symptoms of pulmonary infection should be taken seriously, and both common and uncommon pathogens must be considered in the differential diagnosis. The management of pulmonary infections in rheumatic patients can be challenging, sometimes requiring cessation of immunomodulatory therapy and consultation with infectious diseases specialists, and should be tailored to the individual patient.