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. 2018 May;70(5):679-684.
doi: 10.1002/acr.23426. Epub 2018 Mar 11.

Impact of Sustained Remission on the Risk of Serious Infection in Patients With Rheumatoid Arthritis

Neil A Accortt  1 , Tamara Lesperance  2 , Mei Liu  3 , Sabrina Rebello  3 , Mona Trivedi  1 , Youfu Li  4 , Jeffrey R Curtis  5
Affiliations

Impact of Sustained Remission on the Risk of Serious Infection in Patients With Rheumatoid Arthritis

Neil A Accortt et al. Arthritis Care Res (Hoboken). 2018 May.

Abstract

Objective: This retrospective analysis examined how sustained remission impacted risk of serious infections in patients with rheumatoid arthritis (RA) enrolled in a clinical registry.

Methods: Inclusion criteria included RA diagnosis, age ≥18 years, and ≥2 Clinical Disease Activity Index (CDAI) scores followed by a followup visit. Index date was the second of 2 visits in which a patient had sustained remission (CDAI ≤2.8), low disease activity (LDA; 2.8 < CDAI ≤10), or moderate-to-high disease activity (MHDA; CDAI >10). Followup extended from the index date until first serious infection (requiring intravenous antibiotics or hospitalization) or last followup visit. The crude incidence rate (IR) per 100 patient-years for serious infections was calculated for the sustained remission, LDA, and MHDA groups. The multivariable-adjusted incidence rate ratio (IRR) (adjusted for age, sex, and prednisone dose) compared serious infection rates across disease activity groups.

Results: Most patients were female (>70%); mean age was approximately 60 years. The crude IR (95% confidence interval [95% CI]) per 100 patient-years for serious infections was 1.03 (0.85-1.26) in the sustained remission group (n = 3,355), 1.92 (1.68-2.19) in the sustained LDA group (n = 3,912), and 2.51 (2.23-2.82) in the sustained MHDA group (n = 5,062). Compared to sustained remission, the serious infection rate was higher in sustained LDA (adjusted IRR 1.69 [95% CI 1.32-2.15]). Compared to sustained LDA, the serious infection rate was higher in sustained MHDA (adjusted IRR 1.30 [95% CI 1.09-1.56]).

Conclusion: In this study, lower RA disease activity was associated with lower serious infection rates. This finding may motivate patients and health care providers to strive for remission rather than only LDA.

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Figures

Figure 1
Figure 1
Adjusted incidence rate ratios (IRRs) for risk of infection. 95% CI = 95% confidence intervals; LDA = low disease activity; MHDA = moderate‐to‐high‐disease activity.
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