• Juliana Barbosa Brunelli, Ana Renata Schmidt, Adriana Maluf Elias Sallum, Claudia Goldenstein-Schainberg, Eloisa Bonfá, Clovis A Silva, and Nádia Emi Aikawa.
• a Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , São Paulo , Brazil.
• Mod Rheumatol. 2018 Mar 1; 28 (2): 264-270.

ObjectivesTo assess the rate of serious and/or opportunistic infections in juvenile idiopathic arthritis (JIA) patients from a single tertiary center under biologic therapy and to identify possible risk factors associated to these complications.MethodsA total of 107 JIA patients followed at the biologic therapy center of our tertiary university hospital using a standardized electronic database protocol including demographic data, clinical and laboratorial findings and treatment at baseline and at the moment of infection. Opportunistic infections included tuberculosis, herpes zoster and systemic mycosis.ResultsA total of 398 patient-yrs(py) were included. The median time of biologic exposure was 3.0 years (0.15-11.5). We observed 35 serious/opportunistic infectious events in 27 (25%) patients: 31(88.6%) were serious infections and four (11.4%) opportunistic infections. Serious/opportunistic infections rates were 10.6/100py for ETN, 10.9/100py for ADA, 2.6/100py for ABA and 14.8/100py for TCZ. Comparison of 27 patients with and 80 without infection showed a higher frequency of systemic-onset JIA, lower age at biologic therapy initiation and a history of previous serious infection (p < .05) in the former group.ConclusionsThis study demonstrated a high rate of serious infections in JIA patients under biologic therapy in a real-life setting. Systemic-onset JIA, lower age at biologic therapy start and history of previous serious infections were important risk factors for these complications. Also, higher rates of severe infections comparing to the former studies was possibly due to elevated MTX doses in our patients.

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