Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia - Associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy
Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia - Associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy
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DOI：
10.1002/art.21568
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发表时间：
2006-02-01
影响因子：
--
通讯作者：
Michaud, K
中科院分区：
文献类型：
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作者：
Wolfe, F;Caplan, L;Michaud, K
目标。肺炎是类风湿性关节炎（RA）患者死亡和发病的主要原因。本研究旨在确定肺炎住院率和预测因素，以及特定类风湿性关节炎治疗增加肺炎风险的程度。RA患者（n = 16,788）每半年评估一次，持续3.5年。通过病历或详细的患者访谈确认为肺炎。协变量包括RA严重程度测量、糖尿病、肺部疾病和心肌梗死。Cox比例风险回归用于确定与类风湿关节炎治疗相关的多变量风险。调整协变量后，泼尼松使用增加了肺炎住院的风险（风险比[HR] 1.7[95%置信区间1.5-2.01]），包括剂量相关的风险增加（5-10 mg/天HR 2.1[95%置信区间1.7-2.71,> 10 mg/天HR 2.3[95%置信区间1.6-3.2]）。来氟米特也增加了风险（危险度为1.2[95%可信区间1.0-1.5]）。依那西普（0.8[95%可信区间0.6-110]）和磺胺氮平（0.7[95%可信区间0.5-1.0]）的hr并未反映出肺炎风险的增加。英夫利昔单抗、阿达木单抗和甲氨蝶呤的hr与零无显著差异。类风湿关节炎患者使用强的松与肺炎风险之间存在剂量相关关系。抗肿瘤坏死因子治疗或甲氨蝶呤治疗未发现风险增加。这些数据对低剂量强的松安全的信念提出了质疑。由于皮质类固醇的使用在类风湿性关节炎中很常见，本研究的结果表明泼尼松暴露可能具有重要的公共卫生后果。
Objective. Pneumonia is a major cause of mortality and morbidity in rheumatoid arthritis (RA). This study was undertaken to determine the rate and predictors of hospitalization for pneumonia and the extent to which specific RA treatments increase pneumonia risk.Methods. RA patients (n = 16,788) were assessed semiannually for 3.5 years. Pneumonia was confirmed by medical records or detailed patient interview. Covariates included RA severity measures, diabetes, pulmonary disease, and myocardial infarction. Cox proportional hazards regression was used to determine the multivariable risk associated with RA treatments.Results. After adjustment for covariates, prednisone use increased the risk of pneumonia hospitalization (hazard ratio [HR) 1.7 [95% confidence interval 1.5-2.01), including a dose-related increase in risk ( 5-10 mg/day HR 2.1 [95% confidence interval 1.7-2.71, > 10 mg/day HR 2.3 [95% confidence interval 1.6-3.2]). Leflunomide also increased the risk (HR 1.2 [95% confidence interval 1.0-1.5]). HRs for etanercept (0.8 [95% confidence interval 0.6-110]) and sulfasalazinc (0.7 [95% confidence interval 0.5-1.0]) did not reflect an increased risk of pneumonia. HRs for infliximab, adalimumab, and methotrexate were not significantly different from zero.Conclusion. There is a dose-related relationship between prednisone use and pneumonia risk in RA. No increase in risk was found for anti-tumor necrosis factor therapy or methotrexate. These data call into question the belief that low-dose prednisone is safe. Because corticosteroid use is common in RA, the results of this study suggest that prednisone exposure may have important public health consequences.