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Transmission of rheumatoid arthritis through blood transfusion: a retrospective cohort study
  1. Søren Andreas Just1,
  2. Klaus Rostgaard2,
  3. Kjell Titlestad ‎3,
  4. Gustaf Edgren4,5,
  5. Christian Erikstrup6,
  6. Henrik Ullum7,
  7. Ole Birger Pedersen8,
  8. Kaspar Rene Nielsen9,
  9. Johan Askling10,11,
  10. Hanne Lindegaard1,2,
  11. Henrik Hjalgrim12
  1. 1Department of Rheumatology, Odense University Hospital, Odense, Denmark
  2. 2Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
  3. 3Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
  4. 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  5. 5Department of Cardiology, Karolinska Institutet, Stockholm, Sweden
  6. 6Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
  7. 7Department of Clinical Immunology, The Blood Bank, Copenhagen, Denmark
  8. 8Department of Clinical Immunology, Næstved Sygehus, Næstved, Denmark
  9. 9Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
  10. 10Department of Medicine, Solna, Clinical Epidemiology Section, Karolinska Institutet, Stockholm, Sweden
  11. 11Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
  12. 12Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Søren Andreas Just, Department of Rheumatology, Odense University Hospital, Odense 5000, Denmark; soeren.andreas.just{at}rsyd.dk

https://doi.org/10.1136/annrheumdis-2017-212844

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    The long preclinical phase of rheumatoid arthritis (RA), where some factors involved in RA pathogenesis circulate peripherally, raises concern of RA transmissibility through blood transfusion.1 Specifically, this possibility is suggested by murine RA models in which anticitrullinated peptide/protein antibodies may induce and enhance arthritis, and precursors of the RA-fibroblast-like synoviocyte cells may aggravate and spread the disease between joints.2 3

    We used a large Danish–Swedish population-based research donations and transfusions database (SCANDAT2) with health register information on 1.5 million blood donors and 2.1 million recipients of their blood to investigate (1) RA occurrence in recipients of blood from donors who later developed RA and (2) clustering of RA among recipients of blood from individual donors, regardless of the donor’s RA status.4–6

    We used two different approaches to analyse RA transmission. First, we identified all donors who developed RA after blood donation. For each of these index donors, we identified up to 10 donors matched on age, sex, county, date of first donation, number of donations and ABO blood group, who were free of …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors All authors have contributed substantially in the process of completing this study. Conception of the study: SAJ, KR, JA, GE, HL, HH. Designing the study: SAJ, KR, JA, GE, HL, HH. Aggregation of data: KR, GE, HH, KT, CE, HU, OBP, KRN. Interpretation of data: all authors. Drafting and revising, final approval and agreement to be accountable: all authors.

    • Funding SAJ is supported by grants from The Danish Rheumatism Association and Odense University Hospital PhD Fund and Fund for clinical research. HH is supported by grants from The Danish Rheumatism Association and Nordic Cancer Union. JA has received grant support from the Swedish Foundation for Strategic Research, the Swedish Research Council and ALF.

    • Competing interests JA has received grants from Abbvie, BMS, Merck, Pfizer, Roche, Samsung and UCB, mainly for safety monitoring via the Swedish ARTIS system.

    • Patient consent Not required.

    • Ethics approval The conduct of this study was approved by the regional ethics review board at Karolinska Institutet in Stockholm, Sweden (reference nos. 2009/1011, 2012/1233, 2013/37 and 2013/787), and by the Danish Data protection agency (reference nos. 2008-54-0472 and 2008-58-0035).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data from the Scandinavian Donations and Transfusions (SCANDAT2) database, constituting the basis for this study, cannot be shared due to Danish and Swedish law.