Infection and Malignancy in Rheumatic Diseases

This issue, edited and crafted by Winthrop and Calabrese, is spectacular. No one could have done a better job. The data and commentary will prove useful not only for what is state-of-the-art but also as a backdrop for research issues in years to come. Friedman and Winthrop discuss immunogenicity of vaccines related to the concomitant use of biologic agents—important issues are highlighted regarding the effectiveness of these vaccinations. They also address the gaps in our knowledge of the safety of live vaccines in our patients regardless of whether they are taking biologic drugs. Barriers to immunization are discussed in the context of public health and societal perspectives—an important contribution by Kirchner and Ruffing. Bryant and Baddley address the continuing problem of opportunistic infection risk with the use of biologic therapies and provide up-to-date information about the safety of different agents. The dilemma regarding malignancy risk is carefully analyzed by Seror and Mariette, noting the major contributions of both meta-analyses of clinical trials and essential information from real-world registries. We are generally reassured, as they indicate.

Bingham and colleagues provide new and timely information about the relationships among cancer chemotherapies and immune-related unwanted events—a potential new era of emerging rheumatic diseases brought on by advances in other fields. Sivaraman and Cohen address the management of RA and the risk of malignancies when utilizing Janus Kinase inhibition; this is clearly an emerging topic as the development of these drugs comes center stage. Calabrese and colleagues discuss progressive multifocal leukoencephalopathy or PML in the setting of our diseases and immune-suppressing drugs—the rare event causing a devastating outcome. Strategies to improve outcome are noted. Eliza Chakravarty provides a stunningly comprehensive review of herpes zoster incidence, pathogenesis, and prevention. The impact of hepatitis C and the rheumatologist is carefully analyzed by Cacoub and colleagues. The risk for hepatitis B reactivation during immunosuppression is continuing to be an ongoing problem for those of us that use biologic agents and care for rheumatic disease patients; Koutsianas and colleagues carefully talk about detection, prophylaxis, and treatment.

I am notably and especially proud of this effort to bring so many important issues together in one issue in the Rheumatic Disease Clinics of North America . Congrats to the editors and contributors.

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