Document Detail

The risk of hospitalized infection in patients with rheumatoid arthritis.
MedLine Citation:
PMID:  18260176     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine whether patients with rheumatoid arthritis (RA) are at increased risk of hospitalized infection and whether the risk varies by RA treatment. METHODS: A retrospective cohort study was conducted using data from a medical and pharmacy claims managed-care database from 1999 to 2006. A total of 24,530 patients were included in the RA cohort; a random sample of non-RA patients served as a comparison cohort (n = 500,000). Rates of hospitalized infection were compared between the cohorts. A nested case-control analysis was performed within the RA cohort to assess the effect of current RA medication use on hospitalized infection risk. RESULTS: A total of 1,993 patients with RA and 11,977 non-RA patients experienced a hospitalized infection. The rate of first hospitalized infection was higher in the RA cohort [adjusted hazard ratio = 2.03; 95% confidence interval (CI) 1.93-2.13]. In the case-control analysis, the current use of biological disease modifying antirheumatic drugs (DMARD) was associated with slightly increased risk of hospitalized infection [rate ratio (RR) = 1.21; 95% CI 1.02-1.43]. Methotrexate and hydroxychloroquine were associated with decreased risk. Oral corticosteroid use increased risk (RR = 1.92; 95% CI 1.67-2.21), and there was a dose-related effect [< or = 5 mg/day: RR = 1.32 (95% CI 1.06-1.63), 6-10 mg/day: RR = 1.94 (95% CI 1.53-2.46), > 10 mg/day: RR = 2.98 (95% CI 2.41-3.69)]. CONCLUSION: These data confirm that individuals with RA are at increased risk of hospitalized infection compared to those without RA. Oral corticosteroid use was associated with a dose-related increase. Biological DMARD use was associated with slightly elevated risk; however, this may reflect confounding and channeling bias.
Allison L Smitten; Hyon K Choi; Marc C Hochberg; Samy Suissa; Teresa A Simon; Marcia A Testa; K Arnold Chan
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-02-01
Journal Detail:
Title:  The Journal of rheumatology     Volume:  35     ISSN:  0315-162X     ISO Abbreviation:  J. Rheumatol.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-06     Completed Date:  2008-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7501984     Medline TA:  J Rheumatol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  387-93     Citation Subset:  IM    
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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MeSH Terms
Adrenal Cortex Hormones / adverse effects*
Antirheumatic Agents / adverse effects*
Arthritis, Rheumatoid / complications,  drug therapy*
Case-Control Studies
Cohort Studies
Cross Infection / etiology*,  immunology
Databases, Factual
Dose-Response Relationship, Drug
Middle Aged
Retrospective Studies
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Antirheumatic Agents
Comment In:
J Rheumatol. 2008 Mar;35(3):375-6   [PMID:  18322972 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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