Comorbidity, rural residence, disease severity, prior infection, DMARDs linked to infection
TUESDAY, Aug. 7 (HealthDay News) -- Elderly adults with rheumatoid arthritis have a considerable risk of serious infection, with antirheumatic drug use increasing the risk, according to a study published online July 25 in Arthritis Care & Research.
Jessica Widdifield, Ph.D., of University of Toronto, and associates examined the risk and risk factors for serious infection in a cohort of 86,039 patients with rheumatoid arthritis, aged 66 years or older, from Ontario health administrative data across 1992 to 2010.
The researchers identified 20,575 infections, for a rate of 46.4 per 1,000 person-years, with respiratory infection, herpes zoster, and skin/soft tissue infection being the most common. Factors that correlated with infection included higher comorbidity, rural residence, markers of disease severity, and history of prior infection. There was a several-fold increase in infection noted with the use of anti-tumor necrosis factor agents and disease modifying antirheumatic drugs (adjusted odds ratio ranging from 1.2 to 3.5), with the greatest effect seen for glucocorticosteroids (odds ratio ranging from 4.0 at low doses to 7.6 at high doses).
"While the relative risk of serious infection was elevated across all antirheumatic treatments, the message should not be that non-use is the way to reduce infection risk in seniors," the authors write. "Rather, seniors with rheumatoid arthritis have significant morbidity related to serious infections and require enhanced vigilance in the management of their pharmacotherapy and comorbidities."
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