Incidence of Infections in Early Arthritis

Meriem Kerbachi¹, Louis Bessette², Cristiano S. Moura³, Sasha Bernatsky⁴, Orit Schieir⁵, Susan J. Bartlett⁶, Carol A Hitchon⁷, Janet E. Pope⁸, Gilles Boire⁹, Boulos Haraoui¹⁰, Edward C. Keystone¹¹, Diane Tin¹², Carter Thorne¹³ and Vivian P. Bykerk¹⁴, ¹McGill University, Montreal, QC, Canada, ²Centre d'ostéoporose et de rhumatologie de Québec (CORQ), Québec, QC, Canada, ³1Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada, ⁴Divisions of Rheumatology and Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, ⁵McGill University, Montreal, ON, Canada, ⁶Department of Medicine, Division of ClinEpi, Rheumatology, Respirology, McGill University, Montreal, QC, Canada, ⁷University of Manitoba, Winnipeg, MB, Canada, ⁸Department of Medicine, Division of Rheumatology, University of Western Ontario, St Joseph's Health Care, London, ON, Canada, ⁹Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke and Universite de Sherbrooke, Sherbrooke, QC, Canada, ¹⁰Institut de Rhumatologie de Montréal, Montreal, QC, Canada, ¹¹Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada, ¹²The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, ¹³University of Toronto, Newmarket, ON, Canada, ¹⁴2-005, Mt Sinai Hospital, Toronto, ON, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Early Rheumatoid Arthritis, infection and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 7, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster III: Comorbidities

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Few studies have focused on analyzing infection risk in recent-onset rheumatoid arthritis (RA).The main objective of this study was to estimate the incidence of infections in patients with early RA, focusing on a multi-centre Canadian cohort of RA patients enrolled within 12 months of symptom onset.

Methods: All patients with early RA (<1 year) enrolled in the cohort were studied. Infections have been reported in a standardized manner by patients at yearly assessments. In each year, a patient was allowed to contribute more than one infection event, provided the event was a new or recurrent (not chronic) infection. From January 2007 to November 2015, we tabulated the total number of infections and generated incidence rates of infections with 95% confidence intervals (CI)

Results: A total of 1728 RA patients met study criteria and were followed for an average of 3.2 years. At the time of recruitment, mean (standard deviation, SD) age was 54.2 years (15.0), majority were Caucasian (N=1,419, 82.1%) and female (N=1,245, 72.0%). Mean symptom duration at cohort entry was 5.8 months (3.0). The mean Disease Activity Score 28 was 5.1 (1.4), Simplified Disease Activity Index 28.6 (15.2) and Clinical Disease Activity Index 27.1 (14.4). One third (571, 33%) of these patients were on steroids at baseline and most (N= 1,566, 90.6%) were on DMARDs, with 1,262 (73.0%) patients having been exposed to MTX. Biologics were used only by 41 (2.37%) patients at the time of cohort entry.

Over the study interval, we recorded 452 infections over a total of 5,525 person-years (81.8 events per 1000 patient-years) and over a quarter of these (125 events) involved hospitalization. Eighty four (18%) of all infectious episodes were pneumonia (15.2 events per 1,000 patient years), with half of these pneumonias being associated with a hospitalization.

Conclusion: Reported infections in this Canadian cohort with early RA was not negligible. Half of reported pneumonia events in early RA involved hospitalization.

Disclosure: M. Kerbachi, None; L. Bessette, None; C. S. Moura, None; S. Bernatsky, None; O. Schieir, None; S. J. Bartlett, PROMIS, 6,Pflizer, UCB, Lilly, 5; C. A. Hitchon, ILAR, 2; J. E. Pope, AbbVie, Amgen, Bayer, BMS, Celtrion, Eli Lilly and Company, Merck, Novartis, Pfizer, Roche, UCB, 5,Amgen, Bayer, BMS, GSK, Merck, Novartis, Pfizer, Roche, UCB, 2; G. Boire, None; B. Haraoui, None; E. C. Keystone, Pfizer, Roche, Janssen, Amgen, BMS, Merck. Merck, Celltrion, Samsung Bioepis, 5; D. Tin, None; C. Thorne, AbbVie, Amgen, Celgene, Lilly, Novartis, Pfizer, Sanofi, and UCB; has served as a consultant for AbbVie, Amgen, Celgene, Centocor, Genzyme, Hospira, Janssen, Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sanofi, and UCB, 2,Medexus/Medac, 8; V. P. Bykerk, Amgen, Bristol-Myers Squibb Company, Gilead, Sanofi-Genzyme/Regeneron, Pfizer Pharmaceuticals, UCB, 5.

To cite this abstract in AMA style:

Kerbachi M, Bessette L, Moura CS, Bernatsky S, Schieir O, Bartlett SJ, Hitchon CA, Pope JE, Boire G, Haraoui B, Keystone EC, Tin D, Thorne C, Bykerk VP. Incidence of Infections in Early Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/incidence-of-infections-in-early-arthritis/. Accessed .

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