Background/Purpose:

Rheumatoid arthritis(RA) patients are at increased risk of infections particularly respiratory infections. These may be augmented due to RA itself and to immunosuppressive durgs, specially biologic therapy. Vaccination programs are designed to decrease infections. In RA patients underwent to Vaccination program previously to start a new or a change in biologic therapy from October 2011; our aim was to assess the incidence of severe respiratory infections and to determine the underlying basal risk factors for the development of these complications.

Methods:

Retrospective study of 401 patients diagnosed with RA who were invited to participate in a protocolled vaccination program from October 2011 to October 2016 in a referral center. The follow-up was made until June 2017 with a minimum follow-up period of 8 months and maximum of 5.5 years. Serious infections were defined as those that required hospitalization or at least one dose of intravenous antibiotic treatment at the emergency room. Information was retrieved from the hospital records.

Only 7 patients refused vaccination (2%). Information was not obtained in 4 of the remaining 394 patients. Therefore, these 4 patients were not included in the assessment.

Results:

We finally studied 390patients (307♀/83♂), mean±SD age 61.28±12.9 years that were vaccinated and followed-up. The main features at the time of vaccination were: median disease duration (4 years), positive rheumatoid factor (56.7%), subcutaneous nodules (4.9%), erosive arthritis (36.9%), pulmonary fibrosis (3.8%), secondary Sjögren syndrome (5.1%), other extraarticular manifestations (14.6%) and rheumatoid vasculitis (5.6%). Most patients had received immunosuppressive drugs before the vaccination program. The most frequently used were systemic corticosteroids (n=228), methotrexate (n=362) and biologic agents (40.3%).

During the follow-up, 42 patients (10.7%) had required hospital admissions due to infections, 17 of them were severe respiratory infections (4.35%). The remaining 25 admissions were in the setting of urinary tract infections (n=12), intraabdominal infections (7), skin and soft tissues (12) and articular (1). Also 12 of these patients had a zoster herpes.

The presence of anti-citrullinated protein antibodies (ACPA) was associated with an increased frequency of admissions due to these infections (TABLE). It was also the case for the presence of a history of biologic therapy prior to vaccination. No association of severe respiratory infection with rheumatoid factor, erosions or pulmonary fibrosis was found

Conclusion:

Vaccinated patients with RA present a low incidence of severe respiratory infections. Positivity for ACPA and the use of biologics prior to vaccination are associated with increased risk of severe respiratory infections in these patients. Therefore, vaccination should be performed prior to the onset of biologic treatment.

TABLE.

*adjusted by age and sex.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-the-developement-of-severe-respiratory-infections-in-patients-with-rheumatoid-arthritis-included-in-a-vaccination-program/