TNF-? inhibitors and post-operative surgical site infections in rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation and systemic complications. Its diagnosis and progression are monitored via biomarkers such as rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (ACPA), and others. However, their predictive utility varies among patients. While some patients respond well to methotrexate, others have better outcomes with drugs like rituximab and tocilizumab. Research is focusing on biomarkers for structural damage, including bone erosion and cartilage destruction, linked to genetic variants like HLA-DRB1, CD40, and IL2RA. Inflammatory and bone/cartilage turnover markers are also under study. Synovial biopsy reveals insights into RA pathophysiology, with synovial heterogeneity associated with therapeutic responses. Blood transcriptome analysis could provide potential biomarkers, such as the Interferon gene signature and IgJ, which reflect disease stage and treatment response. Anti-TNF-alpha treatments have improved RA outcomes but should be used cautiously in heart disease patients. Uncertainty persists about the risk of surgical site infections in patients on TNF inhibitors and the potential increased risk of serious infections with anti-TNF therapy. Vaccination is recommended before anti-TNF treatment. Standardized methodologies and more research are needed to establish effective clinical guidelines.