ARTICLE - B cells: key players in autoimmunity - new biologic therapies for RA

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B Cells: Key Players in Autoimmunity

New Biologic Therapies for RA

Gregg J. Silverman, MD

Professor of Medicine

Director, Rheumatic Diseases Core Center

University of California, San Diego

La Jolla, California

Excerpt:

Clinical experience shows that RA patients as a group are at increased

risk for episodes of pneumonia or bronchitis. In my practice, I have

found that recurrent respiratory infections are seen more frequently

in RA patients on TNF-blocking agents. These infections can occur even

in patients with benign baseline chest x-rays, but this does not rule

out serious underlying pulmonary disease. In a recent prospective

study, high-resolution CT scans showed abnormalities in about half of

RA patients examined, with unsuspected bronchiectasis in almost 20%.5

Such emerging insights should increase our level of suspicion, and we

should have a lower threshold for ordering appropriate diagnostic

testing, including high-resolution CT scans, to identify underlying

problems that could put patients at risk with the use of

immunosuppressive therapy. This is relevant to biologic agents like

TNF-á-blocking agents and also the recently approved agent abatacept

(CTLA-4Ig), which can convey increased risks in RA patients with

preexisting pulmonary disease.

http://www.raoutlook.org/expert_practice/article_pf.cfm?id=49

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