Abstract
Background
Patients with rheumatoid arthritis (RA) are at increased risk of S. aureus bacteremia (SAB) compared with the general population.[1] SAB has high mortality and osteoarticular infection (OAI) is a feared complication associated with persistent pain and disability. It remains unclear if RA is associated with increased risk of OAI or death following SAB. [2, 3]
Objectives
To compare risk of OAI and death in SAB patients with and without RA and to assess risk factors for OAI in RA patients including risk associated with antirheumatic treatment.
Methods
Nationwide cohort study of Danish patients with microbiologically verified first-time SAB from 1 January 2006 to 31 December 2018. We identified RA, OAI, vital status, comorbidities, and RA-related clinical characteristics in the rheumatology registry, DANBIO and other national registries. We estimated 90-day cumulative incidence of OAI (in patients without OAI before SAB) and all-cause mortality (all patients). We computed hazard ratios (HR) by multivariate Cox regression adjusted for a priori known risk factors for each outcome.
Results
We identified 18,274 patients with SAB (n=367 with RA). In RA versus (vs.) non-RA, women comprised 62% vs. 37% and median age was 73 years (interquartile range 65; 80) vs. 70 years (59; 82). Prior OAI (0-3 months before SAB) was diagnosed in 4% vs. 2%. The 90-day cumulative incidence of OAI was 23.1% (95% CI 18.8; 27.6) in RA patients vs. 12.5% (12.1; 13.0) in non-RA (Figure 1) (HR 1.93 (1.54; 2.41) adjusted for age, sex, calendar year, and diabetes mellitus). In RA, use of tumor necrosis factor inhibitors (TNFi) and orthopedic implants were associated with OAI risk (Table 1). Mortality was similar in SAB patients with (35.4% (30.6; 40.3)) and without RA (33.9% (33.2; 34.5) (Figure), (HR 1.04 (0.87; 1.24) adjusted for age, sex, calendar year, chronic liver disease, chronic obstructive pulmonary disease, cancer, congestive heart failure, renal failure).
Patients with rheumatoid arthritis (RA) are at increased risk of S. aureus bacteremia (SAB) compared with the general population.[1] SAB has high mortality and osteoarticular infection (OAI) is a feared complication associated with persistent pain and disability. It remains unclear if RA is associated with increased risk of OAI or death following SAB. [2, 3]
Objectives
To compare risk of OAI and death in SAB patients with and without RA and to assess risk factors for OAI in RA patients including risk associated with antirheumatic treatment.
Methods
Nationwide cohort study of Danish patients with microbiologically verified first-time SAB from 1 January 2006 to 31 December 2018. We identified RA, OAI, vital status, comorbidities, and RA-related clinical characteristics in the rheumatology registry, DANBIO and other national registries. We estimated 90-day cumulative incidence of OAI (in patients without OAI before SAB) and all-cause mortality (all patients). We computed hazard ratios (HR) by multivariate Cox regression adjusted for a priori known risk factors for each outcome.
Results
We identified 18,274 patients with SAB (n=367 with RA). In RA versus (vs.) non-RA, women comprised 62% vs. 37% and median age was 73 years (interquartile range 65; 80) vs. 70 years (59; 82). Prior OAI (0-3 months before SAB) was diagnosed in 4% vs. 2%. The 90-day cumulative incidence of OAI was 23.1% (95% CI 18.8; 27.6) in RA patients vs. 12.5% (12.1; 13.0) in non-RA (Figure 1) (HR 1.93 (1.54; 2.41) adjusted for age, sex, calendar year, and diabetes mellitus). In RA, use of tumor necrosis factor inhibitors (TNFi) and orthopedic implants were associated with OAI risk (Table 1). Mortality was similar in SAB patients with (35.4% (30.6; 40.3)) and without RA (33.9% (33.2; 34.5) (Figure), (HR 1.04 (0.87; 1.24) adjusted for age, sex, calendar year, chronic liver disease, chronic obstructive pulmonary disease, cancer, congestive heart failure, renal failure).
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Annals of the Rheumatic Diseases |
| Vol/bind | 82 |
| Udgave nummer | Suppl 1 |
| Sider (fra-til) | 224-225 |
| Antal sider | 2 |
| ISSN | 0003-4967 |
| DOI | |
| Status | Udgivet - 2023 |