Centre Hospitalier de l'Universtité de Montréal, Montreal, Quebec, Canada.
Arthritis Care Res (Hoboken). 2012 Apr;64(4):581-8. doi: 10.1002/acr.21569.
Giant cell arteritis (GCA) is the most frequent form of vasculitis in adults. We sought to estimate the infectious risk associated with GCA and its treatment.
We conducted a matched historical cohort study using data from The Health Improvement Research Network. Patients with newly diagnosed GCA were matched with up to 6 non-GCA patients by age, sex, general practice, and date of entry into the cohort. Random-effects Poisson regression models were used to obtain incidence rates and rate ratios for lower respiratory tract infections (LRTI), urinary tract infections (UTI), and sepsis, as well as for the subset of these that comprised serious infections (pneumonias, upper UTI, and sepsis). Effect modification by age, sex, and time since diagnosis of GCA was assessed.
A total of 1,664 patients with GCA were matched to 8,078 patients without GCA. Overall, 805 (48%) of the GCA patients and 3,007 (37%) of the non-GCA patients experienced ≥1 episode of systemic infection during followup, with adjusted rate ratios for LRTI, UTI, and serious infections of 1.48 (95% confidence interval [95% CI] 1.34-1.65), 1.27 (95% CI 1.10-1.46), and 1.55 (95% CI 1.22-1.96), respectively (P < 0.001 for all). The rate ratio for sepsis was 1.63 (95% CI 0.78-3.40, P = 0.20). Rate ratios for infection were highest in the first 6 months following diagnosis of GCA and in patients age <75 years, but did not vary by sex.
This is the first study to show that patients with GCA are at increased risk of systemic infections, particularly in the first few months following diagnosis. New GCA medications that allow steroid sparing are needed to treat this condition.
巨细胞动脉炎（GCA）是成人中最常见的血管炎形式。我们旨在评估 GCA 及其治疗相关的感染风险。
我们使用来自健康改善研究网络的数据进行了匹配的历史性队列研究。新诊断为 GCA 的患者与年龄、性别、全科医生和进入队列日期相匹配的多达 6 名非 GCA 患者相匹配。采用随机效应泊松回归模型，获得下呼吸道感染（LRTI）、尿路感染（UTI）和败血症的发病率和率比，以及这些感染中包含严重感染（肺炎、上尿路感染和败血症）的发病率和率比。评估了年龄、性别和 GCA 诊断后时间的效应修饰作用。
共有 1664 名 GCA 患者与 8078 名非 GCA 患者相匹配。在整个随访期间，805 名（48%）GCA 患者和 3007 名（37%）非 GCA 患者发生了≥1 次全身感染，LRTI、UTI 和严重感染的调整后率比分别为 1.48（95%置信区间[95%CI]1.34-1.65）、1.27（95%CI 1.10-1.46）和 1.55（95%CI 1.22-1.96）（均<0.001）。败血症的率比为 1.63（95%CI 0.78-3.40，P=0.20）。GCA 诊断后前 6 个月和年龄<75 岁的患者感染率最高，但性别无差异。
这是第一项表明 GCA 患者发生全身感染风险增加的研究，尤其是在诊断后最初几个月内。需要新的可节省类固醇的 GCA 药物来治疗这种疾病。
