Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis

• Main Authors: Mario Abinun, Jonathan P. Lane, Mark Wood, Mark Friswell, Terence J. Flood, Helen E. Foster
• Format: Article
• Language: English
• Published: Centers for Disease Control and Prevention 2016-10-01
• Series: Emerging Infectious Diseases
• Subjects: Juvenile idiopathic arthritis; combined immunosuppressive and antiinflammatory therapy; biological disease-modifying drugs; anti–TNF-α; TNF-α blocking agents; central venous catheter bacteria
• Online Access: https://wwwnc.cdc.gov/eid/article/22/10/15-1245_article
• ISSN: 1080-6040; 1080-6059

Severe infections are emerging as major risk factors for death among children with juvenile idiopathic arthritis (JIA). In particular, children with refractory JIA treated with long-term, multiple, and often combined immunosuppressive and antiinflammatory agents, including the new biological disease-modifying antirheumatic drugs (DMARDs), are at increased risk for severe infections and death. We investigated 4 persons with JIA who died during 1994–2013, three of overwhelming central venous catheter–related bacterial sepsis caused by coagulase-negative Staphylococus or α-hemolytic Streptococcus infection and 1 of disseminated adenovirus and Epstein-Barr virus infection). All 4 had active JIA refractory to long-term therapy with multiple and combined conventional and biological DMARDs. Two died while receiving high-dose systemic corticosteroids, methotrexate, and after recent exposure to anti–tumor necrosis factor-α biological DMARDs, and 2 during hematopoietic stem cell transplantation procedure. Reporting all cases of severe infections and especially deaths in these children is of paramount importance for accurate surveillance.