RESEARCH - Treatment for RA and the risk of hospitalization for pneumonia

[Guest guest]

2006 Jan 30;54(2):628-634 [Epub ahead of print]

Treatment for rheumatoid arthritis and the risk of hospitalization for

pneumonia: Associations with prednisone, disease-modifying antirheumatic

drugs, and anti-tumor necrosis factor therapy.

Wolfe F, Caplan L, Michaud K.

National Data Bank for Rheumatic Diseases and University of Kansas School of

Medicine, Wichita, Kansas.

OBJECTIVE: Pneumonia is a major cause of mortality and morbidity in

rheumatoid arthritis (RA). This study was undertaken to determine the rate

and predictors of hospitalization for pneumonia and the extent to which

specific RA treatments increase pneumonia risk. METHODS: RA patients (n =

16,788) were assessed semiannually for 3.5 years. Pneumonia was confirmed by

medical records or detailed patient interview. Covariates included RA

severity measures, diabetes, pulmonary disease, and myocardial infarction.

proportional hazards regression was used to determine the multivariable

risk associated with RA treatments. RESULTS: After adjustment for

covariates, prednisone use increased the risk of pneumonia hospitalization

(hazard ratio

---

1.7 [95% confidence interval 1.5-2.0]), including a

dose-related increase in risk (</=5mg/day HR 1.4 [95% confidence interval

1.1-1.6], >5-10 mg/day HR 2.1 [95% confidence interval 1.7-2.7], >10 mg/day

HR 2.3 [95% confidence interval 1.6-3.2]). Leflunomide also increased the

risk (HR 1.2 [95% confidence interval 1.0-1.5]). HRs for etanercept (0.8

[95% confidence interval 0.6-110]) and sulfasalazine (0.7 [95% confidence

interval 0.5-1.0]) did not reflect an increased risk of pneumonia. HRs for

infliximab, adalimumab, and methotrexate were not significantly different

from zero.

CONCLUSION: There is a dose-related relationship between

prednisone use and pneumonia risk in RA. No increase in risk was found for

anti-tumor necrosis factor therapy or methotrexate. These data call into

question the belief that low-dose prednisone is safe. Because corticosteroid

use is common in RA, the results of this study suggest that prednisone

exposure may have important public health consequences.

PMID: 16447241

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6447241 & dopt=Abstract

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org