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.
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.
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.