Skip to main content
Erschienen in: Clinical Rheumatology 10/2016

22.07.2016 | Brief Report

Risk of serious infection in patients with rheumatoid arthritis-associated interstitial lung disease

verfasst von: Jorge A. Zamora-Legoff, Megan L. Krause, Cynthia S. Crowson, Jay H. Ryu, Eric L. Matteson

Erschienen in: Clinical Rheumatology | Ausgabe 10/2016

Einloggen, um Zugang zu erhalten

Abstract

The objective of this study is to assess the occurrence of and risk factors for serious infections in rheumatoid arthritis (RA)-associated interstitial lung disease (ILD). All patients with RA-ILD (ACR 1987 criteria for RA) seen at a single center from 1998 to 2014 were identified and manually screened for study inclusion. Follow-up data were abstracted until death or December 31, 2015. Serious infection was defined as requiring antimicrobial therapy and hospitalization. Risk of infection was analyzed by person-year (py) methods using time-dependent covariates started when the medication was first used and stopped 30 days after the medication was discontinued. Of the 181 included patients, 87 (48 %) were female. The mean age at ILD diagnosis was 67.4 (±9.9) years, and median follow-up time was 3.1 (range: 0.01 to 14.8) years. Higher infection rates were observed during the first year after ILD diagnosis (14.1 per 100 py) than subsequently (5.7 per 100 py; p = 0.001). Pneumonia was the most common (3.9 per 100 py). Overall infection risk was higher in organizing pneumonia (OP) (27.1 per 100 py) than usual interstitial pneumonia (7.7 per 100 py) or non-specific interstitial pneumonia (5.5 per 100 py) (p < 0.001). The highest infection rate observed was with a daily prednisone use >10 mg per day (15.4 per 100 py). Patients with RA-ILD are at risk of serious infection. Prednisone use >10 mg per day was associated with higher rates of infection. Immunosuppressive drug use governed by concern for risk of infection in patients with ILD resulting in channeling bias cannot be excluded.
Literatur
2.
Zurück zum Zitat Doyle JJ, Eliasson AH, Argyros GJ, Dennis GJ, Finger DR, Hurwitz KM et al (2000) Prevalence of pulmonary disorders in patients with newly diagnosed rheumatoid arthritis. Clin Rheumatol 19(3):217–221CrossRefPubMed Doyle JJ, Eliasson AH, Argyros GJ, Dennis GJ, Finger DR, Hurwitz KM et al (2000) Prevalence of pulmonary disorders in patients with newly diagnosed rheumatoid arthritis. Clin Rheumatol 19(3):217–221CrossRefPubMed
3.
Zurück zum Zitat Bongartz T, Nannini C, Medina-Velasquez YF, Achenbach SJ, Crowson CS, Ryu JH et al (2010) Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 62(6):1583–1591. doi:10.1002/art.27405 CrossRefPubMedPubMedCentral Bongartz T, Nannini C, Medina-Velasquez YF, Achenbach SJ, Crowson CS, Ryu JH et al (2010) Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 62(6):1583–1591. doi:10.​1002/​art.​27405 CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46(9):2287–2293. doi:10.1002/art.10524 CrossRefPubMed Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46(9):2287–2293. doi:10.​1002/​art.​10524 CrossRefPubMed
6.
Zurück zum Zitat Her M, Kavanaugh A (2016) Alterations in immune function with biologic therapies for autoimmune disease. J Allergy Clin Immunol 137(1):19–27CrossRefPubMed Her M, Kavanaugh A (2016) Alterations in immune function with biologic therapies for autoimmune disease. J Allergy Clin Immunol 137(1):19–27CrossRefPubMed
7.
Zurück zum Zitat Panos RJ, Mortenson RL, Niccoli SA, King TE Jr (1990) Clinical deterioration in patients with idiopathic pulmonary fibrosis: causes and assessment. Am J Med 88(4):396–404CrossRefPubMed Panos RJ, Mortenson RL, Niccoli SA, King TE Jr (1990) Clinical deterioration in patients with idiopathic pulmonary fibrosis: causes and assessment. Am J Med 88(4):396–404CrossRefPubMed
8.
10.
Zurück zum Zitat Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324CrossRefPubMed Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324CrossRefPubMed
12.
Zurück zum Zitat Turesson C, Jacobsson L, Bergstrom U (1999) Extra-articular rheumatoid arthritis: prevalence and mortality. Rheumatology (Oxford) 38(7):668–674CrossRef Turesson C, Jacobsson L, Bergstrom U (1999) Extra-articular rheumatoid arthritis: prevalence and mortality. Rheumatology (Oxford) 38(7):668–674CrossRef
15.
Zurück zum Zitat Conway R, Low C, Coughlan RJ, O’Donnell MJ, Carey JJ (2016) Leflunomide use and risk of lung disease in rheumatoid arthritis: a systematic literature review and metaanalysis of randomized controlled trials. J Rheumatol 43(5):855–860. doi:10.3899/jrheum.150674 CrossRefPubMed Conway R, Low C, Coughlan RJ, O’Donnell MJ, Carey JJ (2016) Leflunomide use and risk of lung disease in rheumatoid arthritis: a systematic literature review and metaanalysis of randomized controlled trials. J Rheumatol 43(5):855–860. doi:10.​3899/​jrheum.​150674 CrossRefPubMed
18.
Zurück zum Zitat Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG et al (2013) An official American Thoracic Society/European respiratory society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188(6):733–748. doi:10.1164/rccm.201308-1483ST CrossRefPubMed Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG et al (2013) An official American Thoracic Society/European respiratory society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 188(6):733–748. doi:10.​1164/​rccm.​201308-1483ST CrossRefPubMed
19.
Zurück zum Zitat Tsuchiya Y, Takayanagi N, Sugiura H, Miyahara Y, Tokunaga D, Kawabata Y et al (2011) Lung diseases directly associated with rheumatoid arthritis and their relationship to outcome. Eur Respir J 37(6):1411–1417. doi:10.1183/09031936.00019210 CrossRefPubMed Tsuchiya Y, Takayanagi N, Sugiura H, Miyahara Y, Tokunaga D, Kawabata Y et al (2011) Lung diseases directly associated with rheumatoid arthritis and their relationship to outcome. Eur Respir J 37(6):1411–1417. doi:10.​1183/​09031936.​00019210 CrossRefPubMed
Metadaten
Titel
Risk of serious infection in patients with rheumatoid arthritis-associated interstitial lung disease
verfasst von
Jorge A. Zamora-Legoff
Megan L. Krause
Cynthia S. Crowson
Jay H. Ryu
Eric L. Matteson
Publikationsdatum
22.07.2016
Verlag
Springer London
Erschienen in
Clinical Rheumatology / Ausgabe 10/2016
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI
https://doi.org/10.1007/s10067-016-3357-z

Weitere Artikel der Ausgabe 10/2016

Clinical Rheumatology 10/2016 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.