Background There has been rapid progress in the treatment of rheumatoid arthritis (RA) in the last decade and it has become more important to manage various complications, such as infection, in RA patients. Although hospitalization is sometimes unavoidable in RA patients (1, 2), there are only a small number of reports on this issue.
Objectives To analyze hospitalization and risk factors for hospitalized infection in RA patients.
Methods Data were obtained from Japanese RA patients in a large, prospective, observational, cohort study of RA, the IORRA. Hospitalizations from October 2009 to September 2010 were recorded based on self-reporting and then confirmed by medical records. The incidence for each cause of hospitalization was calculated. Background factors between patients hospitalized with infection and those who were not were evaluated using Fisher’s exact probability test or the Mann-Whitney test, as appropriate. Risk factors for hospitalized infection were determined using multiple logistic regression.
Results A total of 6,168 patients were analyzed that included 5,182.5 person-years of observation, with 427 hospitalizations (8.24/100 person-years) in 363 patients being confirmed. The causes of hospitalization were infection in 81 (1.56/100 person-years) in 78 patients, orthopedic diseases except planned joint surgery in 45 (0.87/100 person-years), digestive diseases in 43 (0.83/100 person-years), malignancy in 42 (0.81/100 person-years), circulatory diseases in 35 (0.68/100 person-years), ophthalmological diseases in 35 (0.68/100 person-years), and extra-articular symptoms of RA in 24 (0.46/100 person-years). Patients with hospitalized infection were significantly older and had higher disease activity, worse physical dysfunction, lower serum albumin level, and frequent use of corticosteroids (p<0.05). The risks for hospitalized infection were a low serum albumin level (OR 2.6, 95%CI 1.2-6.1) and corticosteroid use (OR 2.4, 95%CI 1.4-4.3).
Conclusions The most frequent cause for hospitalization in RA patients was infection, with associated risks being hypoalbuminemia and steroid use.
Frederick Wolfe et al, Arthritis Rheum 2006; 54: 628-34.
Karen Au et al, Ann Rheum Dis 2011; 70: 785-91.
Disclosure of Interest N. Sugimoto: None Declared, A. Nakajima: None Declared, E. Inoue: None Declared, A. Kobayashi: None Declared, D. Hoshi: None Declared, K. Shidara: None Declared, E. Sato: None Declared, Y. Seto: None Declared, E. Tanaka: None Declared, A. Taniguchi: None Declared, S. Momohara: None Declared, H. Yamanaka Grant/Research support from: IORRA study is supported by 40 pharmaceutical companies;Asahikasei Kuraray Medical Co.,Ltd. Abbott Japan Co.,Ltd. Asahikasei Pharma Corporation Astellas harma Inc. AstraZeneca K.K. Bristol-Myers Squibb Chugai Pharmaceutical Co.,Ltd. Daiichi Fine Chemical Co.,Ltd. Daiichi Sankyo Co.,Ltd. Dainippon Sumitomo Pharma Co.,Ltd. Eisai Co.,Ltd. GlaxoSmithKline K.K. Hisamitsu Pharmaceutical Co.,Inc. Janssen Pharmaceutical K.K. Japan Tobacco Inc. Kaken Pharmaceutical Co.,Ltd. Kissei Pharmaceutical Co., Ltd. Kowa Pharmaceutical Co.Ltd. Maruho Co.,Ltd. Mitsubishi Chemical Medience Corporation Mitsubishi Tanabe Pharma Corporation Mochida Pharmaceutical Co., Ltd. MSD K.K., Mundipharma K.K. Nippon Chemiphar Co.,Ltd. Nippon Shinyaku Co.,Ltd. Novartis Pharma K.K. Otsuka Pharmaceutical Co.,Ltd. Pfizer Japan Inc. Sanofi-Aventis K.K. Santen Pharmaceutical Co.,Ltd. Sanwa Kagaku Kenkyusho Co.,Ltd. Sekisui Medical Co.,Ltd. Shionogi Co.,Ltd. Taishotoyama Pharmaceutical Co.,Ltd. Takeda Pharmaceutical Company Limited Teijin Pharma Limited Torii Pharmaceutical Co.,Ltd. UCB Japan Co. Ltd. ZERIA Pharmaceutical Co.,Ltd., Consultant for: Abbott, AstraZeneca, Bristol-Myers Squibb, Chugai, Eisai, Janssen, Mitsubishi Tanabe., Pfizer, Takeda, Teijin Pharma, UCB