Nossent Johannes C, Keen Helen I, Preen David B, Inderjeeth Charles A
Department Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.
Rheumatology Group, School of Medicine, University Western Australia, 35 Stirling Highway (M503), Perth, Australia.
Rheumatol Ther. 2023 Jun;10(3):563-573. doi: 10.1007/s40744-023-00534-4. Epub 2023 Feb 4.
As immune-modulating therapy has become the standard of care for idiopathic inflammatory joint diseases (IJD), we investigated whether this has changed the rates for hospitalization with opportunistic infections (OI).
Administrative longitudinal state-wide health data identified patients hospitalized at least twice with diagnostic codes for rheumatoid arthritis (RA, n = 7730), psoriatic arthritis (PsA, n = 529) or axial spondylarthritis (AS, n = 1126) in Western Australia in the period 1985-2015. Overall incidence rates/1000 person-years (IR with 95% CI) for microbiologically confirmed OI (mycobacterial, fungal, and viral infections) during 180,963 person-years were analyzed across 10-year periods with IR trend rates analyzed by least square regression (R) for all IJD categories.
A total of 2584 OI occurred with higher IR rates observed in RA (15.34, CI 14.71-15.99) than PsA (8.73, CI 7.14-10.56) and AS (10.88, CI 9.63-12.24) patients (p < 0.001). IR rates were highest for Candidiasis across all three IJD categories (IR 10.0 vs. 6.32 vs. 6.88, respectively), while Varicella-zoster (VZV) was most frequent non-candida OI (IR 2.83.0 vs. 1.50 vs. 1.49, respectively) followed by mycobacterial (IR 1.14 vs. 0.08 vs. 0.24, respectively) and other mycotic infections (IR 0.60 vs. 0.58 vs. 0.86, respectively). Over time, the IR for tuberculosis and pneumocystosis decreased and remained stable for VZV infections in RA patients, but IR for all other OI increased across all disease categories. OI admission associated with 6.5% (CI 5.6-7.5) in-hospital mortality.
Despite decreasing admission rates for tuberculosis and pneumocystosis in RA patients, an overall increase in mycotic and viral infection rates over time was seen across all three IJD. Together with a significant case fatality rate, this indicates continued efforts are needed to improve OI prevention in the management of IJD patients.
由于免疫调节疗法已成为特发性炎性关节病（IJD）的标准治疗方法，我们调查了这是否改变了机会性感染（OI）的住院率。
通过行政纵向全州健康数据，确定了1985 - 2015年期间在西澳大利亚州因类风湿性关节炎（RA，n = 7730）、银屑病关节炎（PsA，n = 529）或轴性脊柱关节炎（AS，n = 1126）的诊断代码而至少住院两次的患者。在180,963人年期间，对微生物学确诊的OI（分枝杆菌、真菌和病毒感染）的总体发病率/1000人年（IR及95%可信区间）进行了分析，跨越10年时间段，对所有IJD类别通过最小二乘法回归（R）分析IR趋势率。
共发生2584例OI，RA患者（15.34，CI 14.71 - 15.99）的IR率高于PsA患者（8.73，CI 7.14 - 10.56）和AS患者（10.88，CI 9.63 - 12.24）（p < 0.001）。在所有三种IJD类别中，念珠菌病的IR率最高（分别为IR 10.0、6.32和6.88），而水痘带状疱疹（VZV）是最常见的非念珠菌OI（分别为IR 2.83、1.50和1.49），其次是分枝杆菌感染（分别为IR 1.14、0.08和0.24）和其他霉菌感染（分别为IR 0.60、0.58和0.86）。随着时间的推移，RA患者中结核病和肺孢子菌病的IR率下降，VZV感染的IR率保持稳定，但所有其他OI的IR率在所有疾病类别中均有所增加。OI住院与6.5%（CI 5.6 - 7.5）的住院死亡率相关。
尽管RA患者中结核病和肺孢子菌病的住院率有所下降，但所有三种IJD中真菌和病毒感染率随时间总体呈上升趋势。连同显著的病死率，这表明在IJD患者管理中仍需继续努力改善OI的预防。
