Risk of septic arthritis in patients with rheumatoid arthritis and the effect of anti-TNF therapy: results from the British Society for Rheumatology Biologics Register

Abstract

ObjectivesTo evaluate the risk of septic arthritis (SA) in patients with rheumatoid arthritis (RA) treated with anti-tumour necrosis factor (TNF) therapy.MethodsUsing data from the British Society for Rheumatology Biologics Register, a prospective observational study, the authors compared the risk of SA between 11 881 anti-TNF-treated and 3673 non-biological disease-modifying antirheumatic drug (nbDMARD)-treated patients.Results199 patients had at least one episode of SA (anti-TNF: 179, nbDMARD: 20). Incidence rates were: anti-TNF 4.2/1000 patient years (pyrs) follow-up (95% CI 3.6 to 4.8), nbDMARD 1.8/1000 pyrs (95% CI 1.1 to 2.7). The adjusted HR for SA in the anti-TNF cohort was 2.3 (95% CI 1.2 to 4.4). The risk did not differ significantly between the three agents: adalimumab, etanercept and infliximab. The risk was highest in the early months of therapy. The patterns of reported organisms differed in the anti-TNF cohort. Prior joint replacement surgery was a risk factor for SA in all patients. The rate of postoperative joint infection (within 90 days of surgery) was 0.7%. This risk was not significantly influenced by anti-TNF therapy.ConclusionsAnti-TNF therapy use in RA is associated with a doubling in the risk of SA. Physicians and surgeons assessing the RA patient should be aware of this potentially life-threatening complication.

Does Combined Clinical and Ultrasound Assessment Allow Selection of Individuals With Rheumatoid Arthritis for Sustained Reduction of Anti–Tumor Necrosis Factor Therapy?

“…Despite the clinical efficacy of anti-TNF therapies and a generally reassuring safety profile, some concerns remain regarding their long-term use due to the increased incidence of serious infections, tuberculosis (10,11), and potential malignancies (12). The cost of anti-TNF therapy is also an important consideration and leads to restrictions on prescribing in many countries (13).…”

Late Onset Prosthetic Hip Joint Infection in Two Patients of Rheumatoid Arthritis Treated With Etanercept

“…5 Galloway et al 6 reported that exposure to TNF blocker therapy was associated with an increased risk of joint infection in patients with RA. This risk was greatest in the first year of treatment.…”

Perioperative Surgical Site Infections and Complications in Elective Orthopedic Surgery in Patients with Rheumatoid Arthritis Treated with Anti-Tumor Necrosis Factor-Alpha Agents − Discontinue or Not, Clinical Dilemma

“…The risk did not differ significantly between the three agents: infliximab (IFX), etanercept (ETN) and adalimumab (ADA). The hazard for SA in the anti-TNF cohort was greatest in the early months of therapy, as well as data from other cohorts [12], and the risk then decreased steadily over the remainder of the follow-up period [11]. One of the potential explanations for early increased risk is that it may reflect a true reduction in risk of joint infection in patients who achieve better control of their RA [11].…”

“…Galloway et al [11] conducted a prospective observational study to evaluate the risk of SA in patients with RA treated with anti-TNF-α agents. They reported that incidence rates for SA were anti-TNF 4.2/1000/patient years (95% CI 3.6-4.8) and nbDMARDs 1.8/1000/ patient years (95% CI 1.1-2.7).…”