Zamora-Legoff Jorge A, Krause Megan L, Crowson Cynthia S, Ryu Jay H, Matteson Eric L
Division of Rheumatology, 200 First Street SW, Rochester, MN 55905, USA.
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA.
Clin Rheumatol. 2016 Oct;35(10):2585-9. doi: 10.1007/s10067-016-3357-z. Epub 2016 Jul 22.
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.
本研究的目的是评估类风湿关节炎（RA）相关间质性肺病（ILD）中严重感染的发生率及危险因素。确定了1998年至2014年在单一中心就诊的所有符合RA-ILD（1987年美国风湿病学会RA标准）的患者，并人工筛选纳入研究。随访数据提取至死亡或2015年12月31日。严重感染定义为需要抗菌治疗并住院。采用人年（py）方法，使用自首次用药开始并在停药后30天停止的时间依赖性协变量分析感染风险。在纳入的181例患者中，87例（48%）为女性。ILD诊断时的平均年龄为67.4（±9.9）岁，中位随访时间为3.1年（范围：0.01至14.8年）。ILD诊断后的第一年感染率较高（每100人年14.1例），随后较低（每100人年5.7例；p = 0.001）。肺炎是最常见的（每100人年3.9例）。机化性肺炎（OP）的总体感染风险高于寻常型间质性肺炎（每100人年7.7例）或非特异性间质性肺炎（每100人年5.5例）（p < 0.001）。观察到的最高感染率是每天使用泼尼松>10 mg（每100人年15.4例）。RA-ILD患者有发生严重感染的风险。每天使用泼尼松>10 mg与较高的感染率相关。不能排除因担心ILD患者感染风险而使用免疫抑制药物导致的渠道偏倚。
