Frequency of infection in patients with rheumatoid arthritis compared with controls - A population-based study
Frequency of infection in patients with rheumatoid arthritis compared with controls - A population-based study
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DOI：
10.1002/art.10524
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发表时间：
2002-09-01
影响因子：
--
通讯作者：
Gabriel, SE
中科院分区：
文献类型：
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作者：
Doran, MF;Crowson, CS;Gabriel, SE
目标。在病例系列报告中描述了类风湿关节炎（RA）并发感染的高频率。本回顾性纵向队列研究旨在比较以人群为基础的类风湿关节炎发病率队列患者与来自同一人群的非类风湿关节炎个体的感染频率。RA患者包括明尼苏达州罗切斯特市所有年龄大于或等于18岁的居民，他们在1955年至1994年间首次被诊断为RA。每个RA患者选择一个年龄和性别匹配的无RA受试者。通过审查研究对象的整个医疗记录对其进行随访，直到死亡、从该地区迁移或研究结束（2000年1月1日），并记录所有记录感染的详细信息以及感染的潜在危险因素信息。感染的风险比使用分层的安德森-吉尔比例风险模型进行估计，并对潜在的混杂因素进行调整。609例RA患者和609例非RA研究对象（平均年龄58.0岁，其中73.1%为女性）的平均随访时间分别为12:7年和15.0年，反映RA组的死亡率更高。经年龄、性别、吸烟状况、白细胞减少、皮质类固醇使用和糖尿病校正后，客观确诊感染、需要住院治疗的感染和任何记录感染的风险比分别为1.70（95%可信区间[95% CI] 1.42-2.03）、1.83 （95% CI 1.52-2.21）和1.45 （95% CI 1.29-1.64）。感染风险最高的部位为骨、关节、皮肤、软组织和呼吸道。在这项研究中，与非RA受试者相比，RA患者发生感染的风险增加。这可能是由于类风湿关节炎的免疫调节作用，或在其治疗中使用具有免疫抑制作用的药物。
Objective. A high frequency of infections complicating rheumatoid arthritis (RA) has been described in reports of case series. This retrospective longitudinal cohort study was undertaken to compare the frequency of infections in a population-based incidence cohort of RA patients with that in a group of individuals without RA from the same population.Methods. RA patients included all members of an incidence cohort of Rochester, Minnesota residents ages greater than or equal to 18 years who were first diagnosed as having RA between 1955 and 1994. One age- and sex-matched subject without RA was selected for each patient with RA. Study subjects were followed up by review of their entire medical record until death, migration from the area, or study end (January 1, 2000), and details of all documented infections, along with information on potential risk factors for infection, were recorded. Hazard ratios for infections were estimated using stratified Andersen-Gill proportional hazards models, with adjustment for potential confounders.Results. The 609 RA patients and 609 non-RA study subjects (mean age 58.0 years; 73.1% female) were followed up for a mean of 12:7 years and 15.0 years, respectively, reflecting higher mortality among the group with RA. Hazards ratios for objectively confirmed infections, infections requiring hospitalization, and any documented infection in patients with RA were 1.70 (95% confidence interval [95% CI] 1.42-2.03),1.83 (95% CI 1.52-2.21), and 1.45 (95% CI 1.29-1.64), respectively, after adjustment for age, sex, smoking status, leukopenia, corticosteroid use, and diabetes mellitus. Sites of infection with the highest risk ratios were bone, joints, skin, soft tissues, and the respiratory tract.Conclusion. In this study, patients with RA were at increased risk of developing infections compared with non-RA subjects. This may be due to immunomodulatory effects of RA, or to agents with immunosuppressive effects used in its treatment.