Prednisone Risks Significant for Pneumonia in Rheumatoid Arthritis Patients

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ACR: Prednisone Risks Significant for Pneumonia in Rheumatoid ArthritisPatientsBy Bruce SylvesterSAN ANTONIO, TX -- October 22, 2004 -- Rheumatoid arthritis patients beingtreated with prednisone have a significantly higher risk of developingpneumonia than patients using biologic medications, researchers reportedhere on October 20th at the 68th Annual Scientific Meeting of the AmericanCollege of Rheumatology."While it is good news that the increased rate of pneumonia in people takingbiologics is relatively low, the risk of pneumonia associated withprednisone use is substantial," said investigator Frederick Wolfe, MD,director, National Data Bank for Rheumatic Diseases, Wichita, Kansas. "Thismeans that rather than being a relatively benign therapy, prednisone appearsto be a significant contributor to the risks associated with development ofpneumonia in the treatment of rheumatoid arthritis."Dr. Wolfe and colleagues undertook a 2 and a half year study that comparedthe risks of biologic therapy and prednisone use in 15,966 patients withlong-term arthritis and an average age of 60.5 years. The investigatorsevaluated patient responses to semi-annual questionnaires that were alsovalidated by analysis of medical and death records.Results show that 53.0% used a biologic agent, 18.7% usedhydroxychloroquine, 55.7% used methotrexate, 32.4% used a disease-modifyingantirheumatic agent (DMARD) without a tumor necrosis factor agent, 10.2%used neither a DMARD nor a biologic agent, and 38.4 % used prednisone withor without other agents.Dr. Wolfe reported that subjects who used biologic drugs were 30% morelikely to get pneumonia, and subjects who used prednisone were 170% morelikely to get pneumonia compared to subjects who used other treatments.An estimated 35% to 45% of patients treated for rheumatoid arthritiscurrently use prednisone, and more than 70% of patients will use it at somepoint, Dr. Wolfe said.Functional status and disease severity was somewhat predictive of infection,but the study results suggest that steroid therapy could play a largerdetrimental role than previously known, he noted."These data indicate an increased risk among biologic users, but alsodemonstrate a much larger risk from corticosteroids, and suggest moreattention should be paid to this commonly used but less safe therapy, heconcluded.[Presentation title: Rates and Predictors of Pneumonia in Patients WithRheumatoid Arthritis: Strong Association With Corticosteroid Therapy.Abstract 1763]