Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study
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 i...
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BMJ Publishing Group
2019-06-01
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| Series: | RMD Open |
| Online Access: | https://rmdopen.bmj.com/content/5/1/e000935.full |
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| author | Gulsen Ozen Sofia Pedro Frederick Wolfe Kaleb Michaud Bella Mehta Andre Kalil Ted Mikuls |
| author_facet | Gulsen Ozen Sofia Pedro Frederick Wolfe Kaleb Michaud Bella Mehta Andre Kalil Ted Mikuls |
| author_sort | Gulsen Ozen |
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| description | 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. |
| format | Article |
| id | doaj-art-1d1dadb4aa264544ab7398dcf511c18d |
| institution | Kabale University |
| issn | 2056-5933 |
| language | English |
| publishDate | 2019-06-01 |
| publisher | BMJ Publishing Group |
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| series | RMD Open |
| spelling | doaj-art-1d1dadb4aa264544ab7398dcf511c18d2025-08-20T03:50:48ZengBMJ Publishing GroupRMD Open2056-59332019-06-015110.1136/rmdopen-2019-000935Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort studyGulsen Ozen0Sofia Pedro1Frederick Wolfe2Kaleb Michaud3Bella Mehta4Andre Kalil5Ted Mikuls6Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USAForward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USAForward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USAForward, The National Databank for Rheumatic Diseases, Wichita, Kansas, USADepartment of Medicine, Hospital for Special Surgery, New York, New York, USADepartment of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USADepartment of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USAObjectives 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.https://rmdopen.bmj.com/content/5/1/e000935.full |
| spellingShingle | Gulsen Ozen Sofia Pedro Frederick Wolfe Kaleb Michaud Bella Mehta Andre Kalil Ted Mikuls Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study RMD Open |
| title | Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study |
| title_full | Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study |
| title_fullStr | Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study |
| title_full_unstemmed | Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study |
| title_short | Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study |
| title_sort | serious infection risk in rheumatoid arthritis compared with non inflammatory rheumatic and musculoskeletal diseases a us national cohort study |
| url | https://rmdopen.bmj.com/content/5/1/e000935.full |
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