RESEARCH - The risk of hospitalized infection in patients with RA

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Journal of Rheumatology

March 2008

The Risk of Hospitalized Infection in Patients with Rheumatoid Arthritis

ALLISON L. SMITTEN, HYON K. CHOI, MARC C. HOCHBERG, SAMY SUISSA,

TERESA A. SIMON, MARCIA A. TESTA, and K. ARNOLD CHAN

ABSTRACT.

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¨C2.13]. 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¨C1.43]. Methotrexate and

hydroxychloroquine were associated with decreased risk. Oral

corticosteroid use increased risk (RR = 1.92; 95% CI 1.67¨C2.21), and

there was a dose-related effect [¡Ü 5 mg/day: RR = 1.32 (95% CI

1.06¨C1.63), 6¨C10 mg/day: RR = 1.94 (95% CI 1.53¨C2.46), > 10 mg/day: RR

= 2.98 (95% CI 2.41¨C3.69)].

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. (First

Release Feb 1 2008; J Rheumatol 2008;35:387-93)

http://www.jrheum.com/abstracts/abstracts08/387.html

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