Infections induced by low-dose corticosteroids in rheumatoid arthritis: A systematic literature review

doi:10.1016/j.jbspin.2010.02.009

Joint Bone Spine

Volume 77, Issue 3, May 2010, Pages 246-251

https://doi.org/10.1016/j.jbspin.2010.02.009 Get rights and content

Abstract

Objective

To study the association between infection risk and low-dose corticosteroids (LD-CT, defined as a daily dose < 10 mg/day of prednisone) in rheumatoid arthritis (RA).

Methods

Data source: a systematic review of the literature up to June 2009 was performed. Data extraction :all type of infections: bacterial, viral and postoperative; infection severity, RA activity, RA severity, comorbid conditions. Data analysis: descriptive, comparing infection risk between LD-CT-treated and LD-CT-not treated RA.

Results

Of the 1310 screened reports, the literature analysis identified 15 assessing infection risk of LD-CT in RA patients. Of the eight reports that studied all types of infection, six articles found no association between risk of infection and LD-CT, one showed an association between severe infections and LD-CT (OR = 8 [1–64]) and another showed a dose-dependent association including doses of less than 5 mg/day: RR = 1.32 [1.06–1.63] and doses between 6 to 10 mg/day: RR = 1.95 [1.53–2.46]. Of the three trials that studied infection risk secondary to bacteria, one showed an increased risk (HR = 1.7 [1.5–2.0]) while two did not (respectively, exposure to < 5 mg/day: OR = 1.34 [0.85–2.13]; 6 to 9 mg/day: OR = 1.53 [0.95–2.48] and < 5 mg/day: OR = 1.49 [0.82–2.72]; 5 to 10 mg/day: OR = 1.46 [0.84–2.54]). None of the three trials studying postoperative infection risk found any association between infection risk and LD-CT treatment. Two reports studied herpes zoster risk and found no association with LD-CT.

Conclusion

There was a paucity of data about LD-CT and infection risk in RA and that risk seems poorly increased. These findings need to be confirmed by further studies.

Section snippets

Literature search

A systematic literature search was performed using databases of Medline, Embase and Cochrane Library. The keywords used for the Medline search were: (“Arthritis, Rheumatoid/complications” [Mesh:NoExp] OR “Arthritis, Rheumatoid/drug therapy” [Mesh:NoExp]) AND (“Bacterial Infections and Mycoses”[Mesh] OR “Virus Diseases”[Mesh] OR “Parasitic Diseases”[Mesh]) NOT “Case Reports”[ptyp]. The search was limited to English, French, Spanish and German languages, humans and adults above 19 years old with

Results

The literature search on electronic databases identified 1408 titles (Fig. 1). After reading titles and abstracts, 98 articles were selected as described previously and read. Finally, 15 full-length articles were included in the analysis and one abstract from international congresses was added.

Discussion

The systematic literature search pointed out that only few data about risk of infection induced by LD-CT have been identified and showed a poor increase of that risk. Although risk of infections is likely to be increased with moderate or high doses, most studies that explored the risk associated with LD-CT failed to demonstrate this. When analysing specific bacterial infections, pneumonia was associated with LD-CT in one study [26], but this result was not confirmed by two other studies [24],

Conflict of interest statement

The authors received a grant support from Abbott.

Acknowledgments

The authors thank Abbott for an institutional support for this study, Philippe Gaudin, Daniel Wendling^, Alain Cantagrel^, Pascal Claudepierre^, Jean-Francis Maillefert^, Thierry Schaeverbeke and Jacques Tebib for their help in elaborating the study and interpretation of the data.

References (34)

A.M. Boerbooms et al.
Infections during low-dose methotrexate treatment in rheumatoid arthritis
Semin Arthritis Rheum
(1995)
A. Schnabel et al.
Major infection during methotrexate treatment for rheumatoid arthritis
Semin Arthritis Rheum
(1996)
D.C. Dale et al.
Corticosteroids and infectious diseases
Med Clin North Am
(1973)
K.G. Saag et al.
Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events
Am J Med
(1994)
A. Jain et al.
Influence of steroids and methotrexate on wound complications after elective rheumatoid hand and wrist surgery
J Hand Surg [Am]
(2002)
M.A. Antonelli et al.
Herpes zoster in patients with rheumatoid arthritis treated with weekly, low-dose methotrexate
Am J Med
(1991)
D.M. Mitchell et al.
Survival, prognosis, and causes of death in rheumatoid arthritis
Arthritis Rheum
(1986)
D.P. Symmons et al.
Long-term mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well
J Rheumatol
(1998)
F. Wolfe et al.
The mortality of rheumatoid arthritis
Arthritis Rheum
(1994)
G.A. van Albada-Kuipers et al.
Frequency of infection among patients with rheumatoid arthritis versus patients with osteoarthritis or soft tissue rheumatism
Arthritis Rheum
(1988)

J.P. Vandenbroucke et al.

Frequency of infections among rheumatoid arthritis patients, before and after disease onset

Arthritis Rheum

(1987)

N. Feltelius et al.

Results from a nationwide postmarketing cohort study of patients in Sweden treated with etanercept

Ann Rheum Dis

(2005)

S. Kroesen et al.

Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-alpha therapy

Rheumatology (Oxford).

(2003)

C. Salliot et al.

Infections during tumour necrosis factor-alpha blocker therapy for rheumatic diseases in daily practice: a systematic retrospective study of 709 patients

Rheumatology (Oxford)

(2007)

L. Wei et al.

Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease

Ann Intern Med

(2004)

J.M. Piper et al.

Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs

Ann Intern Med

(1991)

T.P. van Staa et al.

Oral corticosteroids and fracture risk: relationship to daily and cumulative doses

Rheumatology (Oxford)

(2000)

Cited by (46)

Risk of infections in psoriatic arthritis or axial spondyloarthritis patients treated with targeted therapies: A meta-analysis of randomized controlled trials
2024, Joint Bone Spine
To evaluate the risk of global infections in patients with psoriatic arthritis (PsA) and axial spondyloarthritis encompassing ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) treated with targeted therapies.
Medline and Cochrane databases were systematically searched up to March 2021 for randomized controlled trials (RCTs) performed in patients with PsA or axial spondyloarthritis treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Global infections (any infections reported, including bacterial, viral and fungal infections, except serious infections) were the primary outcome. Secondary outcomes included serious infections defined as life-threatening infections or any infection requiring intravenous antibiotics or hospitalization. The relative risk of infections was determined by meta-analysis of RCTs.
A total of 60 RCTs were included (20,418 patients), encompassing 17 b/tsDMARDs, compared with placebo, conventional synthetic drugs (csDMARDs) or non-steroidal anti-inflammatory drugs (NSAIDs). An increased risk of any infection for patients exposed to these drugs was found (RR 1.15, 95% CI [1.06–1.25]), mainly with high doses and longer duration of treatment. Most infections were respiratory tract or ear, nose, and throat (ENT) infections. Subgroup analyses showed a statistically significant increased risk of infections for axial spondyloarthritis patients (RR 1.32, 95% CI [1.14–1.52]), but not for PsA patients (RR 1.05, 95% CI [0.97–1.14]). Infection risk was highest with TNF inhibitors (RR 1.23, 95% CI [1.11–1.37]) and IL-17 inhibitors (RR 1.30, 95% CI [1.07–1.59]). No increased risk of serious infections was shown.
In contrast to serious infections, the risk of global infections is moderately increased with b/tsDMARDs in spondyloarthritis, and is associated in particular with use of TNF and IL-17 inhibitors.
Spondylodiscitis on recto-rachidian fistula after non-restored sigmoid resection
2021, Journal of Visceral Surgery
After non-restored sigmoid resection and terminal colostomy, the rectal stump can reopen, thereby occasioning a number of problems. We are reporting the case of a 79-year-old female patient who presented with spondylodiscitis due to a recto-rachidian fistula on a rectal stump subsequent to non-restored sigmoid resection. This case sheds light on a rare rectal stump complication. Initial treatment consisting in rectal drainage via transanal route did not suffice; rectal stump resection with omentoplasty was necessary.
Anergy and immunosuppression in patients with rheumatoid arthritis
2021, Revista Colombiana de Reumatologia
The newly discovered natural compounds against rheumatoid arthritis-an overview
2019, Phytochemistry Letters
Citation Excerpt :
In addition, headaches, cognitive disorders, allergic reactions often make patients stop treatment, thus greatly limiting the use of NSAIDs. The long-term application of corticosteroids can induce infection, hypersplenism, hypertension, osteoporosis and fractures (Van Staa et al., 2000; Adeline et al., 2010; Walker and Edwards, 1994; Satyanarayanasetty et al., 2015). DMARDs cause vomiting, diarrhea, rashes, decreased white blood cell levels, and impaired liver and kidney functions (Ruderman, 2012; Gilani et al., 2012).
Rheumatoid arthritis (RA) is a chronic disease characterized by inflammatory synovitis. It can lead to symmetry and invasive inflammation of joints, and eventually lead to joint deformity and loss of function. Medical treatment is a common and effective method of treating rheumatoid arthritis in clinics. Naturally derived compounds can be one of the options in medical therapy. Many anti-rheumatoid arthritis compounds have been found from natural medicines, especially Chinese herbs. In order to understand the progresses in these compounds, we collected nearly 10-year reports on anti-rheumatoid arthritis compounds in PubMed database and summarized the pharmacological properties of the compounds. In this study, we collected 18 natural compounds with potential anti-rheumatoid arthritis effects while these compounds are still far from clinical applications. Herein, we compared the pharmacological characteristics of these compounds in order to search for novel candidate compounds with high clinical potential for anti-rheumatoid arthritis.
Infections Associated with Biologics
2017, Infectious Diseases, 2-Volume Set
Patient-specific risk factors for infection in arthroplasty procedure
2016, Orthopaedics and Traumatology: Surgery and Research
All patients are not equally at risk when it comes to postoperative infections, whether the risks are related to the environment or the patient. Patient-specific infection risk factors for arthroplasty should be a focal point during the preoperative consultation as they impact the treatment decision. Eighty percent of patients have at least one modifiable infection risk factor. These risk factors must be corrected preoperatively whenever possible so that the patient is operated under the best possible conditions, with the lowest possible infection risk. The screenings and preoperative preparations are multidisciplinary but must also involve the patient. The information provided to the patient must match the patient's infectious risk profile. This lecture will review every infection risk factor, whether it is modifiable or not, and then suggest how the treatment decision should be adapted to each patient's infection risk.

View all citing articles on Scopus

View full text

Original articleInfections induced by low-dose corticosteroids in rheumatoid arthritis: A systematic literature review

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Literature search

Results

Discussion

Conflict of interest statement

Acknowledgments

Semin Arthritis Rheum

Semin Arthritis Rheum

Med Clin North Am

Am J Med

J Hand Surg [Am]

Am J Med

Survival, prognosis, and causes of death in rheumatoid arthritis

Arthritis Rheum

Long-term mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well

J Rheumatol

The mortality of rheumatoid arthritis

Arthritis Rheum

Frequency of infection among patients with rheumatoid arthritis versus patients with osteoarthritis or soft tissue rheumatism

Arthritis Rheum

Frequency of infections among rheumatoid arthritis patients, before and after disease onset

Arthritis Rheum

Results from a nationwide postmarketing cohort study of patients in Sweden treated with etanercept

Ann Rheum Dis

Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-alpha therapy

Rheumatology (Oxford).

Infections during tumour necrosis factor-alpha blocker therapy for rheumatic diseases in daily practice: a systematic retrospective study of 709 patients

Rheumatology (Oxford)

Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease

Ann Intern Med

Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs

Ann Intern Med

Oral corticosteroids and fracture risk: relationship to daily and cumulative doses

Rheumatology (Oxford)

Original article
Infections induced by low-dose corticosteroids in rheumatoid arthritis: A systematic literature review