Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis

Widdifield J, Bernatsky S, Paterson MJ, Gunraj N, Carter Thorne J, Pope J, Cividino A, Bombardier C. Arthritis Care Res. 2013; 65(3):353-61. Epub 2013 Feb 26.


Objective – To assess risk and risk factors for serious infections in seniors with rheumatoid arthritis (RA) using a case control study nested within an RA cohort.

Methods – The researchers assembled a retrospective RA cohort aged ≥66 years from Ontario health administrative data across 1992-2010. Nested case-control analyses were done, comparing RA patients with a primary diagnosis of infection (based on hospital or emergency department records) to matched RA controls. We assessed independent effects of drugs, adjusting for demographics, co-morbidity, and markers of RA severity.

Results – 86,039 seniors with RA experienced 20,575 infections for a rate of 46.4 events/1,000 person-years. The most frequently occurring events included respiratory infections, herpes zoster and skin/soft-tissue infections. Factors associated with infection included higher co-morbidity, rural residence, markers of disease severity, and history of previous infection. In addition, anti-TNF agents and disease-modifying anti-rheumatic drugs were associated with a several-fold increase in infections with an adjusted odds ratio (OR) ranging from 1.2 to 3.5. The drug category with the greatest effect estimate was glucocorticosteroids, which exhibited a clear dose response with an OR ranging from 4.0 at low doses to 7.6 at high doses.

Conclusions – Seniors with RA have significant morbidity related to serious infections, which exceeds previous reports among younger RA populations. Rural residence, higher co-morbidity, markers of disease severity, and previous infection were associated with serious infections in seniors with RA. The results emphasize that many RA drugs may increase risk of infection, but glucocorticosteroids appear to confer a particular risk.

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