Journal article
Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study
Rheumatic & musculoskeletal diseases open, Vol.5(1), pp.e000935-e000935
06/01/2019
DOI: 10.1136/rmdopen-2019-000935
PMCID: PMC6560658
PMID: 31245055
Abstract
Objectives To identify serious infection (SI) risk by aetiology and site in patients with rheumatoid arthritis (RA) compared with those with non-inflammatory rheumatic and musculoskeletal diseases (NIRMD).
Methods Patients participating in FORWARD from 2001 to 2016 were assessed for SIs; defined by infections requiring hospitalisation, intravenous antibiotics or followed by death. SIs were categorised by aetiology and site. SI risk was assessed through Cox proportional hazards models. Best models were selected using machine learning Least Absolute Shrinkage and Selection Operator (LASSO) methodology.
Results Among 20 361 patients with RA and 6176 patients with NIRMD, 1600 and 276 first SIs were identified, respectively. Incidence of SIs was higher in RA compared with NIRMD (IRR = 1.5; 95% CI 1.2 to 1.5). The risk persisted after adjusting using the LASSO model (HR 1.7; 95% CI 1.5 to 1.8), but attenuated when additionally adjusted for glucocorticoid use (HR 1.3; 95% CI 1.2 to 1.5). SI risk was significantly higher in RA versus NIRMD for bacterial infections as well as for respiratory, skin, bone, joint, bloodstream infections and sepsis irrespective of glucocorticoid use. Compared with NIRMD, SI risk was significantly increased in patients with RA who were in moderate and high disease activity but was similar to those in low disease activity/remission (p trend < 0.001).
Conclusions The risk of all SIs, particularly bacterial, respiratory, bloodstream, sepsis, skin, bone and joint infections are significantly increased in patients with RA compared with patients with NIRMD. This infection risk appears to be greatest in those with higher RA disease activity.
Details
- Title: Subtitle
- Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study
- Creators
- Bella Mehta - Hospital for Special SurgerySofia Pedro - The National Databank for Rheumatic DiseasesGulsen Ozen - University of Nebraska Medical CenterAndre Kalil - University of Nebraska Medical CenterFrederick Wolfe - The National Databank for Rheumatic DiseasesTed M. Kuls - Univ Nebraska Med Ctr, Dept Med, Omaha, NE 68198 USAKaleb Michaud - The National Databank for Rheumatic Diseases
- Resource Type
- Journal article
- Publication Details
- Rheumatic & musculoskeletal diseases open, Vol.5(1), pp.e000935-e000935
- Publisher
- Bmj Publishing Group
- DOI
- 10.1136/rmdopen-2019-000935
- PMID
- 31245055
- PMCID
- PMC6560658
- ISSN
- 2056-5933
- eISSN
- 2056-5933
- Number of pages
- 9
- Grant note
- U54GM115458 / National Institutes of Health/National Institute of General Medical Sciences; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of General Medical Sciences (NIGMS) C Ronald MacKenzie Young Scientist Endowment Award Rheumatology Research Foundation U54GM115458 / NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of General Medical Sciences (NIGMS)
- Language
- English
- Date published
- 06/01/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984702822002771
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