Factors associated with severe skin infections in patients treated with biologic therapies for inflammatory rheumatic diseases

Dermatology. 2012;224(1):72-83. doi: 10.1159/000337422. Epub 2012 Apr 6.


Background: The incidence of severe infections is increased under biologic therapies and the skin is the second localization.

Objective: To appraise the factors associated with severe skin infections (SSI) in patients under biologic therapies for inflammatory rheumatic diseases (IRD).

Methods: We performed a case-control (ratio 1:3) study nested in a prospective cohort of patients with IRD. SSI was defined as requiring hospitalization or intravenous anti-infectious therapy. We defined two imbedded periods: period A was the time window between the first biologic therapy and the SSI; period B was the last 3 or 12 months (for tumor necrosis factor blockers or rituximab, respectively) before the SSI.

Results: Among 4,361 patients with IRD, 29 had a SSI under biologic therapy. In multivariate analyses, SSI were significantly associated with smoking, baseline C-reactive protein and gammaglobulinemia, non-steroidal anti-inflammatory drugs before biologic therapy, cumulative dose of steroids, concomitant steroids during period A, number of different biologic therapies during period A, treatment with infliximab during period A, period B or as first biologic therapy and treatment at high dose during period B.

Conclusion: In patients under biologic therapies for IRD, the risk of SSI is associated with several factors including tobacco, treatment with infliximab or high dose range.

MeSH terms

  • Adalimumab
  • Aged
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antibodies, Monoclonal, Murine-Derived / adverse effects
  • Antirheumatic Agents / adverse effects*
  • Biological Products / adverse effects*
  • Case-Control Studies
  • Cohort Studies
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / adverse effects
  • Infliximab
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Randomized Controlled Trials as Topic
  • Receptors, Tumor Necrosis Factor
  • Rheumatic Diseases / drug therapy*
  • Risk Factors
  • Rituximab
  • Severity of Illness Index
  • Skin Diseases, Infectious / chemically induced*
  • Time Factors
  • Tumor Necrosis Factor-alpha / adverse effects*


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Monoclonal, Murine-Derived
  • Antirheumatic Agents
  • Biological Products
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Rituximab
  • Infliximab
  • Adalimumab
  • Etanercept