Frequency of infection in patients with rheumatoid arthritis compared with controls: A population-based study

Michele F. Doran, Cynthia Crowson, Gregory R. Pond, W. Michael O'Fallon, Sherine E. Gabriel

Research output: Contribution to journalArticle

749 Citations (Scopus)

Abstract

Objective. A high frequency of infections complicating rheumatoid arthritis (RA) has been described in reports of case series. This retrospective longitudinal cohort study was undertaken to compare the frequency of infections in a population-based incidence cohort of RA patients with that in a group of individuals without RA from the same population. Methods. RA patients included all members of an incidence cohort of Rochester, Minnesota residents ages ≥18 years who were first diagnosed as having RA between 1955 and 1994. One age- and sex-matched subject without RA was selected for each patient with RA. Study subjects were followed up by review of their entire medical record until death, migration from the area, or study end (January 1, 2000), and details of all documented infections, along with information on potential risk factors for infection, were recorded. Hazard ratios for infections were estimated using stratified Andersen-Gill proportional hazards models, with adjustment for potential confounders. Results. The 609 RA patients and 609 non-RA study subjects (mean age 58.0 years; 73.1% female) were followed up for a mean of 12.7 years and 15.0 years, respectively, reflecting higher mortality among the group with RA. Hazards ratios for objectively confirmed infections, infections requiring hospitalization, and any documented infection in patients with RA were 1.70 (95% confidence interval [95% CI] 1.42-2.03), 1.83 (95% CI 1.52-2.21), and 1.45 (95% CI 1.29-1.64), respectively, after adjustment for age, sex, smoking status, leukopenia, corticosteroid use, and diabetes mellitus. Sites of infection with the highest risk ratios were bone, joints, skin, soft tissues, and the respiratory tract. Conclusion. In this study, patients with RA were at increased risk of developing infections compared with non-RA subjects. This may be due to immunomodulatory effects of RA, or to agents with immunosuppressive effects used in its treatment.

Original languageEnglish (US)
Pages (from-to)2287-2293
Number of pages7
JournalArthritis and Rheumatism
Volume46
Issue number9
DOIs
StatePublished - Sep 1 2002

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Rheumatoid Arthritis
Infection
Population
Confidence Intervals
Arthritis
Incidence
Leukopenia
Immunosuppressive Agents
Proportional Hazards Models
Respiratory System
Medical Records
Longitudinal Studies
Diabetes Mellitus
Adrenal Cortex Hormones
Hospitalization
Cohort Studies
Joints
Smoking
Odds Ratio
Bone and Bones

ASJC Scopus subject areas

  • Immunology
  • Rheumatology

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Frequency of infection in patients with rheumatoid arthritis compared with controls : A population-based study. / Doran, Michele F.; Crowson, Cynthia; Pond, Gregory R.; O'Fallon, W. Michael; Gabriel, Sherine E.

In: Arthritis and Rheumatism, Vol. 46, No. 9, 01.09.2002, p. 2287-2293.

Research output: Contribution to journalArticle

Doran, Michele F. ; Crowson, Cynthia ; Pond, Gregory R. ; O'Fallon, W. Michael ; Gabriel, Sherine E. / Frequency of infection in patients with rheumatoid arthritis compared with controls : A population-based study. In: Arthritis and Rheumatism. 2002 ; Vol. 46, No. 9. pp. 2287-2293.
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abstract = "Objective. A high frequency of infections complicating rheumatoid arthritis (RA) has been described in reports of case series. This retrospective longitudinal cohort study was undertaken to compare the frequency of infections in a population-based incidence cohort of RA patients with that in a group of individuals without RA from the same population. Methods. RA patients included all members of an incidence cohort of Rochester, Minnesota residents ages ≥18 years who were first diagnosed as having RA between 1955 and 1994. One age- and sex-matched subject without RA was selected for each patient with RA. Study subjects were followed up by review of their entire medical record until death, migration from the area, or study end (January 1, 2000), and details of all documented infections, along with information on potential risk factors for infection, were recorded. Hazard ratios for infections were estimated using stratified Andersen-Gill proportional hazards models, with adjustment for potential confounders. Results. The 609 RA patients and 609 non-RA study subjects (mean age 58.0 years; 73.1{\%} female) were followed up for a mean of 12.7 years and 15.0 years, respectively, reflecting higher mortality among the group with RA. Hazards ratios for objectively confirmed infections, infections requiring hospitalization, and any documented infection in patients with RA were 1.70 (95{\%} confidence interval [95{\%} CI] 1.42-2.03), 1.83 (95{\%} CI 1.52-2.21), and 1.45 (95{\%} CI 1.29-1.64), respectively, after adjustment for age, sex, smoking status, leukopenia, corticosteroid use, and diabetes mellitus. Sites of infection with the highest risk ratios were bone, joints, skin, soft tissues, and the respiratory tract. Conclusion. In this study, patients with RA were at increased risk of developing infections compared with non-RA subjects. This may be due to immunomodulatory effects of RA, or to agents with immunosuppressive effects used in its treatment.",
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