Background The treatment of JIA has become more effective by means of biological disease modifying antirheumatic drugs (DMARDs). Biological DMARDs, however, increase the risk of infections.
Objectives The aim of the study is to find out the incidence and the individual risk factors for bloodstream infections in JIA.
Methods The Social Insurance Institution (SII) register of reimbursement of medicines and National Infectious Disease Register (National Institute of Health and Welfare) were used to identify JIA patients aged 2-18 years hospitalized for BSI during the years 2004-2011. Antirheumatic treatment of JIA was searched by using SII nationwide register. We also analysed the incidence of BSI in JIA patients with new diagnosis during the study period, and compared it with BSI in Finnish population of same age and study period.
Results By means of combination of the register data we found a total of 10 patients (11 episodes) with BSI during the study period. The median age of children was 14 years. One patient had two distinct episodes of BSI. Pneumonia was the most common focus of infection. The following bacteria were detected: Staphylococcus aureus (4 cases), Streptococcus pneumoniae (3 cases), Staphylococcus epidermidis, Escherichia coli, Fusobacterium necroforum and Pseudomonas aeruginosa in one patient, respectively. Six patients were on biological DMARD and four on glucocorticoid treatment.
We identified 1604 patients with JIA diagnosed in 2004-2011 with 6630 patient years of follow-up. Five JIA patients (7.5 infections/10 000 patient years, 95% CI 2.4 – 17.6) and 2184 control population subjects (2.8 infections/ 10 000 patient years, 95% CI 2.7 – 2.9) had BSI.
Conclusions Bloodstream infections seem to be rare in patients with JIA. Interestingly, half of the patients with BSI were on biological DMARDs. Compared with control population, the standardized incidence ratio for BSI in JIA patients was 3.0 (95% CI 1.25 – 7.20).
References Hashkes PJ, Uziel Y, Laxer RM. The safety profile of biologic therapies for juvenile idiopathic arthritis. Nat Rev Rheumatol 2010;6:561-571.
Beukelman T, Xie F, Chen L et al. Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment. Arthritis Rheum 2012;64:2773-2780.
Disclosure of Interest None Declared