Franklin Jarrod, Lunt Mark, Bunn Diane, Symmons Deborah, Silman Alan
Epidemiology Research Unit, Manchester University Medical School, Manchester M13 9PT, UK.
Ann Rheum Dis. 2007 Mar;66(3):308-12. doi: 10.1136/ard.2006.057265. Epub 2006 Sep 19.
The increased mortality observed in patients with rheumatoid arthritis is partly due to an increased occurrence of serious infections. A retrospective study from the Mayo Clinic found that infection risk is increased in rheumatoid arthritis. In particular, serious infection was associated with severe disease and use of corticosteroids. Robust estimates are required from prospective studies of incident cases.
To examine the risk of infection leading to hospitalisation and potential factors associated with this risk in an unselected population of patients with inflammatory polyarthritis.
A prospective cohort study comparing infection incidence in new-onset patients with inflammatory polyarthritis with local population experience.
2108 patients with inflammatory polyarthritis from a community-based register were studied and followed up annually (median 9.2 years). The rate of hospitalisations for serious infection was compared with the rate of hospitalisations in the regional population. The contribution of potential predictors was assessed by undertaking a within-cohort analysis.
Overall, the incidence of infection was more than two and a half times that of the general population (varying by site). History of smoking, corticosteroid use and rheumatoid factor were found to be significantly independent predictors of infection-related hospitalisation. Patients with inflammatory polyarthritis with all three factors were more than seven times as likely to be hospitalised compared with the rest of the cohort.
These findings provide background data on the risk of infection associated with rheumatoid arthritis, and are of particular interest given the current awareness of the risk of infection associated with anti-tumour necrosis factoralpha treatments.
类风湿关节炎患者死亡率增加部分归因于严重感染发生率上升。梅奥诊所的一项回顾性研究发现类风湿关节炎患者感染风险增加。特别是，严重感染与疾病严重程度及使用皮质类固醇有关。需要对新发病例进行前瞻性研究以得出可靠估计。
在未选择的炎性多关节炎患者人群中，研究导致住院的感染风险及与此风险相关的潜在因素。
一项前瞻性队列研究，比较炎性多关节炎新发病例的感染发生率与当地人群情况。
对来自社区登记处的2108例炎性多关节炎患者进行研究，并每年随访（中位时间9.2年）。将严重感染的住院率与该地区人群的住院率进行比较。通过队列内分析评估潜在预测因素的作用。
总体而言，感染发生率是普通人群的两倍半以上（因感染部位而异）。吸烟史、使用皮质类固醇和类风湿因子被发现是感染相关住院的显著独立预测因素。具有这三个因素的炎性多关节炎患者住院可能性是队列其他患者的七倍以上。
这些发现提供了与类风湿关节炎相关的感染风险的背景数据，鉴于目前对抗肿瘤坏死因子α治疗相关感染风险的认识，这些发现尤其令人关注。
