[CIS-PAGID] Anti-TNF in pt with selective antibody deficiency

[Hare, Nathaniel D]

Colleagues,


To follow up on Joe Church's question, I basically have the same
question about using IVIG in patients either on a TNF-inhibitor or in
whom one will possibly be started.  In both patients, I am wondering if
I need to add IVIG.  Like Joe, I am wondering if I am being too
cautious.

 

Patient 1

30 yo male with psoriatic arthritis

Treated with methotrexate

Rheumatology wants to add etanercept

Specific Antibody Deficiency (response to 5/23 pneumococcal serotypes
after Pneumovax vaccination, tested while on methotrexate)

Tested b/c of history of recurrent pneumonia that predated the
methotrexate therapy

 

 

Patient 2

47 yo female with symmetric polyarticular inflammation B27 positive CCP
positive, treated with methotrexate and etanercept

Selective IgA deficiency, IgG4 subclass deficiency (for what it's worth)
and specific antibody deficiency (response to 2/23 pneumococcal
serotypes after Pneumovax vaccination, tested while on methotrexate and
etanercept)

Tested b/c history of chronic sinusitis, CT documented.

 

 

Thanks,

 

Nathan Hare

 

 

Nathaniel D. Hare MD

Allergy & Immunology

CMC - Dartmouth Hitchcock Keene

Keene, NH  03431

 

ph  (603) 354-5496

fax (603) 354-5498

________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Friday, May 20, 2011 9:11 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Anti-TNF in pt with selective antibody deficiency

 

Colleagues:

 

I am following a 12yo girl who has rheumatoid arthritis per our
Rheumatology service.  They are recommending anti-TNF therapy.

 

However, she also has IgA deficiency and selective antibody deficiency
(+ response to 2 of 23 pneumococcal serotypes tested after Pneumovax
immunization.  These were evaluated because of recurrent sinusitis.

 

My bias would be to put her on IVIG or SCID while she is receiving
anti-TNF.  Am I being overly cautious?

 

Thank you for your time.

 

Joe Church

Children's Hospital Los Angeles

 

 


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