Article

Frequency of infection in patients with rheumatoid arthritis compared with controls: A population-based study

Mayo Clinic, Rochester, Minnesota 55905, USA.
Arthritis & Rheumatology (Impact Factor: 7.87). 09/2002; 46(9):2287-93. DOI: 10.1002/art.10524
Source: PubMed

ABSTRACT A high frequency of infections complicating rheumatoid arthritis (RA) has been described in reports of case series. This retrospective longitudinal cohort study was undertaken to compare the frequency of infections in a population-based incidence cohort of RA patients with that in a group of individuals without RA from the same population.
RA patients included all members of an incidence cohort of Rochester, Minnesota residents ages >or=18 years who were first diagnosed as having RA between 1955 and 1994. One age- and sex-matched subject without RA was selected for each patient with RA. Study subjects were followed up by review of their entire medical record until death, migration from the area, or study end (January 1, 2000), and details of all documented infections, along with information on potential risk factors for infection, were recorded. Hazard ratios for infections were estimated using stratified Andersen-Gill proportional hazards models, with adjustment for potential confounders.
The 609 RA patients and 609 non-RA study subjects (mean age 58.0 years; 73.1% female) were followed up for a mean of 12.7 years and 15.0 years, respectively, reflecting higher mortality among the group with RA. Hazards ratios for objectively confirmed infections, infections requiring hospitalization, and any documented infection in patients with RA were 1.70 (95% confidence interval [95% CI] 1.42-2.03), 1.83 (95% CI 1.52-2.21), and 1.45 (95% CI 1.29-1.64), respectively, after adjustment for age, sex, smoking status, leukopenia, corticosteroid use, and diabetes mellitus. Sites of infection with the highest risk ratios were bone, joints, skin, soft tissues, and the respiratory tract.
In this study, patients with RA were at increased risk of developing infections compared with non-RA subjects. This may be due to immunomodulatory effects of RA, or to agents with immunosuppressive effects used in its treatment.

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    • "Patients with rheumatoid arthritis (RA) are reported to have an increased susceptibility to infection [1]. Studies of a specific * Corresponding author. "
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    12/2014; 46(1). DOI:10.1016/j.ejcdt.2014.11.027
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    • "The higher rate of infectious events may result from an increased risk of infection inherent to RA (Doran et al., 2002a) (though this appears to have reduced over the last 50 years (Ni Mhuircheartaigh et al., 2013), which is thought to be secondary to immune disturbance associated with disease pathogenesis and the use of immune-modulators to control the condition (Doran et al., 2002a,b). An inherent risk of infection makes establishing a causal link between biologic DMARDs and infections more difficult. "
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    • "Nevertheless, the potential aetiological roles of such bacteria are unknown. Furthermore, data from longitudinal cohort studies have demonstrated that patients with RA are at increased risk of developing infections compared to non-RA subjects [10], and that higher disease activity is associated with a higher probability of developing infections [11]. Moreover, elevated levels of calprotectin (a peptide with antimicrobial and pro-apoptotic effects that is predominantly produced by neutrophils) has been observed in RA serum [12] and atherosclerotic lesions [13]. "
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