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Study finds seniors with rheumatoid arthritis at an increased risk of developing serious infections


New research done at the Institute for Clinical Evaluative Sciences (ICES) in collaboration with the Ontario Biologic Research Initiative (OBRI) finds seniors with rheumatoid arthritis (RA) are at high risk of developing infections requiring a hospitalization or emergency department visit. Their risk exceeds previously reported rates of infection among younger RA populations.

“Few studies have evaluated infection risk among seniors with rheumatoid arthritis. This group is a vulnerable population due to compromised host defense mechanisms related to disease, comorbidities and polypharmacy. Seniors with rheumatoid arthritis have significant morbidity related to serious infections,” says Dr. Sasha Bernatsky, co-author of the study and assistant professor in the Department of Medicine, Divisions of Rheumatology and Clinical Epidemiology, at McGill University Health Centre.

RA affects approximately 1 per cent of the adult population.

The population-based case-control study of Ontarians aged 66 and older with RA from 1998 to 2010 found that:

  • Seniors with RA who lived in rural areas and those with greater comorbidity and more markers of disease severity, as well as a past history of infections, had an increased risk of being hospitalized or having an ED visit for an infection.
  • The most common types of infections among RA patients were respiratory infections (such as pneumonia), skin or soft-tissue infections, and herpes zoster.
  • Many RA drugs increase the risk of infection; however, glucocorticoids appear to confer a particular risk, especially at high doses.

The study found the risk of serious infection was elevated across all RA drugs. However, the authors stress that non-use is not the way to reduce infection risk in seniors. Rather, seniors with RA require enhanced vigilance in the management of their pharmacotherapy and comorbidities.

Authors: Widdifield J, Bernatsky S, Paterson MJ, Gunraj N, Carter Thorne J, Pope J, Cividino A, Bombardier C.

The study “Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis” is in the March 2013 issue of Arthritis Care and Research.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

The Ontario Biologic Research Initiative (OBRI) is a collaboration of multiple stakeholder groups representing rheumatologists, patients and researchers who are interested in the optimal use of treatments for the management of Ontarians living with rheumatoid arthritis.


Read the Journal Article