Influence of disease duration and socioeconomic factors on the prevalence of infection and hospitalization in rheumatoid arthritis: KRAC study

Abstract

Aim: The use of healthcare resources by rheumatoid arthritis (RA) patients can be related to the presence of disease, comorbid conditions, use of steroids, and the combined use of immunosuppressants. This study evaluated the risk factors associated with infection and hospitalization in RA. Methods: This multicenter, cross-sectional study enrolled 3247 RA subjects fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism criteria to examine the prevalence of hospitalization and episodes of documentable non-tubercular infections as a part of the "Karnataka rheumatoid arthritis comorbidity" study (KRAC). The study included 2081 subjects and 1166 were excluded due to incomplete data. Demographic, clinical and treatment variables were collected, and the events related to infections and hospitalization were extracted from the medical records. Comparative analysis and multivariate logistic regression were performed.Results: Around 22% of the subjects had hospitalizations and 2.9% had infections.Infections were pertaining to dental (1.3%), urinary tract (1.6%) and candidiasis (0.2%). Skin-and soft tissue-related infections were found in 1.8% and 0.3% of patients, respectively. Increased need of hospitalization in RA patients was associated with advanced age (≥60 years), lower education, family income, and longer duration of RA. Presence of comorbidity, usage of three or more disease-modifying anti-rheumatic drugs (DMARDs) and family income influenced the likelihood of infection.Dental infections were less likely in working subjects and more likely in patients with increased disease duration, higher family income, comorbidities and those between the age group 40-59 years. Urinary tract infection was associated with DMARD usage. Conclusion: Patient-specific risk factors should be considered to improve treatment strategies and to reduce the risk of infection and hospitalization in RA patients. | 1217 CHANDRASHEKARA Et Al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Chandrashekara S, Shobha V, Dharmanand BG, et al. Influence of disease duration and socioeconomic factors on the prevalence of infection and hospitalization in rheumatoid arthritis: KRAC study. Int J Rheum

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

“…Subsequent data from the FORWARD database demonstrated that 5.9% of patients with RA treated with TNF inhibitors, non-TNF inhibitors, bDMARDs (abatacept, rituximab, tocilizumab and anakinra) or csDMARDs (n = 11,623) experienced an SI during 27,552 patient-years of follow-up [89]. Studies from other parts of the world reinforce the association between RA and the increased burden of infection, with studies from the UK and India reporting that between 3% and 8% of patients with RA experience infections (Table 3) [90,91]. A diagnosis of RA may also increase infection risk in a surgical setting, with a retrospective, US-based case-control study (n = 2212) reporting that RA was associated with a 47% increased risk of postoperative infection following total joint arthroplasty vs. patients with osteoarthritis (odds ratio (OR): 1.47; p = 0.031) [92].…”

“…A number of patient demographics and comorbidities have been shown to be predictive of the observed increased risk of infection in patients with RA [86]. Factors associated with an increased infection risk include male sex [92,93,96], older age [90,93,95,96,110,111], longer RA disease duration [90,93], a history of SIs [88], lower education [90], family income [90], rural residency [88], geographical location [111], poor nutritional status [112] and higher BMI [111]/obesity [92]. Significantly increased infection risks have been described for patients with comorbid conditions including renal dysfunction [93,95,113], pulmonary disease [89], underlying lung disease [93,112] and diabetes [88,92,111].…”

Effectiveness of preemptive antifibrinolysis with tranexamic acid in rheumatoid arthritis patients undergoing total knee arthroplasty: a study protocol for a randomized controlled trial

“…As the one of the most common inflammatory arthritis affecting about 1% of world population [ 1 , 2 ], rheumatoid arthritis (RA) is associated with an increasing socioeconomic impact and often affects the diarthrodial joints, including knee joint [ 3 , 4 ]. Total knee arthroplasty (TKA) is considered one of the most effective orthopedic health care interventions for patients with rheumatoid arthritis (RA) [ 5 – 8 ], and RA patients achieve better satisfaction after TKA compared to patients with osteoarthritis (OA) [ 8 ].…”