Rheumatoid arthritis and the incidence of influenza and influenza-related complications: a retrospective cohort study
Rheumatoid arthritis and the incidence of influenza and influenza-related complications: a retrospective cohort study
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DOI：
10.1186/1471-2474-13-158
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发表时间：
2012-08-27
影响因子：
2.3
通讯作者：
Toovey, Stephen
中科院分区：
文献类型：
--
作者：
Blumentals, William A.;Arreglado, Anna;Toovey, Stephen
背景资料：已知类风湿性关节炎（RA）患者感染的风险增加，特别是如果他们服用具有免疫调节作用的药物。有必要为更多的信息与RA患者的流感风险。方法：回顾性队列研究进行了收集的数据从美国大型商业健康保险数据库（汤姆森路透社Medstat MarketScan）从2000年1月1日至2007年12月31日。患者年龄≥ 18岁，至少有两次RA索赔诊断。在RA患者和匹配的对照中，在流感诊断后30天或30天内扫描数据库以了解季节性流感及其并发症的发生率。其他因素包括医疗条件，使用疾病缓解抗风湿药物（DMARDs），使用生物制剂，流感疫苗接种和高或低剂量皮质类固醇。发病率比（IRRs）计算流感及其并发症的RA patients.Results：46,030例RA患者和匹配数量的对照组的中位年龄为57岁。RA患者的流感发病率高于对照组（409.33 vs 306.12例/100，000患者-年），RA并发症的发病率增加了2.75倍。存在或不存在DMARD或生物制剂没有显著影响。在60-69岁的患者中，调整后的流感IRR具有统计学意义，尤其是男性。当所有年龄组合并时，观察到女性和两性合并（但不仅仅是男性）的流感并发症发生率显著增加。一般而言，未接受DMARD或生物制剂治疗的RA患者发生流感并发症的风险与所有RA患者相似。RA女性患者的肺炎发病率显著较高。中风/心肌梗死（MI）的发病率较高的男性，虽然统计学意义是borderly.Conclusions：RA与季节性流感及其并发症的发病率增加。性别和年龄特异性亚组数据表明，女性的并发症发生率通常高于男性，但男性的卒中和MI并发症发生率主要增加。合并DMARD或生物制剂使用似乎不会显著影响流感或其并发症的发生率。
Background: Patients with rheumatoid arthritis (RA) are known to be at increased risk of infection, particularly if they are taking drugs with immunomodulatory effects. There is a need for more information on the risk of influenza in patients with RA.Methods: A retrospective cohort study was carried out using data gathered from a large US commercial health insurance database (Thomson Reuters Medstat MarketScan) from 1 January 2000 to 31 December 2007. Patients were >= 18 years of age, with at least two RA claims diagnoses. The database was scanned for incidence of seasonal influenza and its complications on or up to 30 days after an influenza diagnosis in RA patients and matched controls. Other factors accounted for included medical conditions, use of disease-modifying anti-rheumatic drugs (DMARDs), use of biological agents, influenza vaccination and high-or low-dose corticosteroids. Incidence rate ratios (IRRs) were calculated for influenza and its complications in patients with RA.Results: 46,030 patients with RA and a matching number of controls had a median age of 57 years. The incidence of influenza was higher in RA patients than in controls (409.33 vs 306.12 cases per 100,000 patient-years), and there was a 2.75-fold increase in incidence of complications in RA. Presence or absence of DMARDs or biologics had no significant effect. The adjusted IRR of influenza was statistically significant in patients aged 60-69 years, and especially among men. A significantly increased rate of influenza complications was observed in women and in both genders combined (but not in men only) when all age groups were combined. In general, the risk of influenza complications was similar in RA patients not receiving DMARDs or biologics to that in all RA patients. Pneumonia rates were significantly higher in women with RA. Rates of stroke/myocardial infarction (MI) were higher in men, although statistical significance was borderline.Conclusions: RA is associated with increased incidence of seasonal influenza and its complications. Gender- and age-specific subgroup data indicate that women generally have a greater rate of complications than men, but that men primarily have an increased rate of stroke and MI complications. Concomitant DMARD or biological use appears not to significantly affect the rate of influenza or its complications.