TY - JOUR AU - Abinun, Mario AU - Lane, Jonathan AU - Wood, Mark AU - Friswell, Mark AU - Flood, Terence AU - Foster, Helen T1 - Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis T2 - Emerging Infectious Disease journal PY - 2016 VL - 22 IS - 10 SP - 1720 SN - 1080-6059 AB - Severe infections are emerging as major risk factors for death among children with juvenile idiopathic arthritis (JIA). In particular, children with refractory JIA treated with long-term, multiple, and often combined immunosuppressive and antiinflammatory agents, including the new biological disease-modifying antirheumatic drugs (DMARDs), are at increased risk for severe infections and death. We investigated 4 persons with JIA who died during 1994–2013, three of overwhelming central venous catheter–related bacterial sepsis caused by coagulase-negative Staphylococus or α-hemolytic Streptococcus infection and 1 of disseminated adenovirus and Epstein-Barr virus infection). All 4 had active JIA refractory to long-term therapy with multiple and combined conventional and biological DMARDs. Two died while receiving high-dose systemic corticosteroids, methotrexate, and after recent exposure to anti–tumor necrosis factor-α biological DMARDs, and 2 during hematopoietic stem cell transplantation procedure. Reporting all cases of severe infections and especially deaths in these children is of paramount importance for accurate surveillance. KW - Juvenile idiopathic arthritis KW - combined immunosuppressive and antiinflammatory therapy KW - biological disease-modifying drugs KW - anti–TNF-α KW - TNF-α blocking agents KW - central venous catheter bacteria KW - children KW - United Kingdom KW - bacteria KW - sepsis KW - immunosuppression DO - 10.3201/eid2210.151245 UR - https://wwwnc.cdc.gov/eid/article/22/10/15-1245_article ER - End of Reference