The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / How to Watch for Immune Deficiencies & Manage Risk

How to Watch for Immune Deficiencies & Manage Risk

July 19, 2018 • By Thomas R. Collins

  • Tweet
  • Email
Print-Friendly Version / Save PDF

CHICAGO—When a patient with rheumatic disease suffers recurrent infections, has a history of multiple autoimmune diseases or presents with atypical autoimmune syndromes, clinicians should consider the possibility of an immune deficiency, an expert said at the ACR State-of-the-Art Clinical Symposium in April.

You Might Also Like
  • 5 Misconceptions about Immune Deficiency
  • Therapies Aimed at Immune Cell Progenitors May Be Key to Reducing Post Myocardial Infarction Risk
  • Immune Checkpoint Inhibitors & Immune-Related Adverse Events
Explore This Issue
July 2018
Also By This Author
  • EULAR 2015: Anti-Inflammatory Drugs with Dual Targets

W. Winn Chatham, MD, professor of medicine at the University of Alabama at Birmingham School of Medicine, said immune deficiency is frequently coupled with rheumatic disease. Patients with the most often seen form, common variable immune deficiency (CVID), have an autoimmune disorder 20–25% of the time, so clinicians must be aware of the signs and know how to manage it.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

The atypical autoimmune syndromes often can’t be attributed to a specific rheumatologic diagnosis, he said. “Most notably, you see this a lot with patients who have seronegative RA,” Dr. Chatham said.

Immunodeficiency may develop in the setting of autoimmune disease because therapy (e.g., cyclophosphamide or azathioprine) induces neutropenia or lymphopenia. Patients can also have primary immunodeficiency, which can arise from autoimmunity that affects the numbers or functions of lymphoid and phagocytic cells, he said.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Identifying Risk

Gwen Shockey / science source

Gwen Shockey / science source

Dr. Chatham suggested using a rule of 500s to mitigate the risk of immune deficiencies associated with immunosuppressive treatment. A neutrophil count below 500/mm3, a T lymphocyte count below 500/mm3 or an IgG serum level below 500 mg/dL is reason to consider a patient at risk of immune deficiency from prescribed therapies, he said.

Physicians can manage severe neutropenia with levofloxacin, low T lymphocytes with trimethoprim-sulfamethaxazole or dapsone, and low IgG counts with IVIG.

A low serum IgG level is an often overlooked sign, he said. “This is one I see that even [clinicians] in our own group, as well as other people in practice using aggressive therapies, probably don’t monitor quite often enough,” he said. “It is also important to remember to check immunoglobulin levels any time you see a patient with new-onset autoimmune disease. It really should be part of the diagnostic evaluation, I think.”

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

To assess for primary immune deficiency, clinicians can measure IgG and IgG subclass levels, check to see if pneumococcal IgG responses are robust after pneumococcal vaccination or order flow cytometry studies to measure circulating B and T cell levels.

“If you get a hit on these with a noted abnormality and suspect a patient has an underlying immune deficiency, genetic testing is actually getting quite reasonable now, quite affordable,” he said. A primary immunodeficiency gene panel can be ordered for a couple of hundred dollars, he said.

Pages: 1 2 | Single Page

Filed Under: Conditions Tagged With: 2018 State of the Art Clinical Symposium, CVID, Immune System, lympopenia, neutropeniaIssue: July 2018

You Might Also Like:
  • 5 Misconceptions about Immune Deficiency
  • Therapies Aimed at Immune Cell Progenitors May Be Key to Reducing Post Myocardial Infarction Risk
  • Immune Checkpoint Inhibitors & Immune-Related Adverse Events
  • Better Blood Pressure Screening Needed to Manage Cardiovascular Disease Risk in Rheumatoid Arthritis

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.