Fungal Infections in Spondyloarthritis Patients Undergoing Biotherapy: Insights from the Moroccan Biotherapy Registry (RBSMR) over a Three-Year Follow-Up Period

Biological therapy increases the risk of fungal infections in chronic inflammatory rheumatism patients. Objectives: To determine the incidence of fungal infections in spondyloarthritis patients on biotherapy in the Moroccan registry (RBSMR) during 3-year follow-up and to identify associated factors. Methods: Patients' socio-demographic, clinical and para-clinical data were collected. The type of biotherapy used and episodes of fungal infections were determinated. Also, the frequency of corticosteroids and NSAIDs use, disease activity, and various comorbidities before and at the time of fungal infection during the 3 years of follow-up were defined. Regarding fungal infection, the germ and location were specified. Results: Seven spondyloarthritis patients out of 194 had a fungal infection (with 8 episodes). Mean age was 44±17 years, with mean disease duration of 11 years. All these patients had comorbidities before and during the fungal infection. At the time of this, all patients were on TNF alpha inhibitors, specifically, one patient was on Adalimumab but later switched to Etanercept, five were on Etanercept, and one was on Infliximab. No case of systemic fungal infection was noted. In the 8 fungal infection episodes, there were 7 cases of appendages’ involvement and 1 case of vaginal candidiasis. Conclusion: The incidence of fungal infections in patients with spondyloarthritis remains low and seems to be related to disease activity and type of biologics.