RESEARCH - Treatment for RA and the risk of hospitalization for pneumonia: association with prednisone

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Arthritis Rheum. 2006 Feb;54(2):628-34.

Treatment for rheumatoid arthritis and the risk of hospitalization for

pneumonia: associations with prednisone, disease-modifying antirheumatic

drugs, and anti-tumor necrosis factor therapy.

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

Medicine, Wichita, Kansas 67214, USA. fwolfe@...

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 (< or = 5 mg/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?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16447241

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