High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis
High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis
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DOI：
10.1136/ard.2010.128637
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发表时间：
2011-05-01
影响因子：
27.4
通讯作者：
Furst, Daniel E.
中科院分区：
文献类型：
--
作者：
Au, Karen;Reed, George;Furst, Daniel E.
目的探讨类风湿关节炎（RA）患者疾病活动性与感染的关系。方法从CORRONA数据库中，确定接受稳定的疾病缓解抗风湿药物、生物制剂和皮质类固醇治疗至少6个月的RA患者中医生报告的感染发生率。定义了疾病活动性的两个复合指标：临床疾病活动性指数（CDAI）和疾病活动性评分28（DAS 28）。发病率比（IRR）的计算采用广义估计方程Poisson回归模型调整人口统计学，药物和临床factors.Results 1 6242例RA患者，6242例稳定治疗至少6个月，符合分析。队列中报告了2282例感染，随访超过7290患者年。在控制了可能的混杂因素后，疾病活动性与感染率增加相关。DAS 28评分每增加0.6个单位，门诊感染率增加4%（IRR 1.04，p=0.01），需要住院治疗的感染率增加25%（IRR 1.25，p=0.03）。感染与CDAI评分之间的关系存在二分法。对于CDAI < 10（轻度疾病活动）的患者，CDAI评分每增加5个单位，门诊感染率增加12%（IRR 1.12，p=0.003）。在CDAI评分>= 10时，与较高疾病活动性相关的门诊感染率没有进一步增加。CDAI与住院感染的关系显示出与门诊数据相似的趋势，但在多变量分析后未达到统计学显著性（CDAI < 10：IRR 1.56，p=0.08）。
Objective To determine the relationship of disease activity to infections in patients with rheumatoid arthritis (RA).Methods From the CORRONA database, the incidence of physician-reported infections in RA patients on stable disease-modifying antirheumatic drug, biological, and corticosteroid therapy for at least 6 months was ascertained. Two composite measures of disease activity were defined: clinical disease activity index (CDAI) and disease activity score 28 (DAS28). Incident rate ratios (IRR) were calculated using generalised estimating equation Poisson regression models adjusted for demographics, medications and clinical factors.Results Of 1 6242 RA patients, 6242 were on stable therapy for at least 6 months and were eligible for analysis. 2282 infections were reported in the cohort, followed over 7290 patient-years. After controlling for possible confounders, disease activity was associated with an increased rate of infections. Each 0.6 unit increase in DAS28 score corresponded to a 4% increased rate of outpatient infections (IRR 1.04, p=0.01) and a 25% increased rate of infections requiring hospitalisation (IRR 1.25, p=0.03). There was a dichotomy in the relationship between infections and CDAI scores. For CDAI < 10 (mild disease activity) patients had a 12% increased rate of outpatient infections with each 5 unit increase in CDAI score (IRR 1.12, p=0.003). At CDAI scores >= 10, there was no further increase in the rate of outpatient infections associated with higher disease activity. The relationship of CDAI to hospitalised infections showed similar trends to outpatient data but did not reach statistical significance after multivariate analysis (CDAI < 10: IRR 1.56, p=0.08).Conclusions In this large cohort of RA patients, higher disease activity was associated with a higher probability of developing infections.