類風濕關節炎患者的複發性感染——來自BSRBR的統計結果
背景：
類風濕關節炎（RA）患者對感染的易感性增加。
目的：
1. 探討英國風濕病學會生物製劑登記類風濕關節炎（BSRBR-RA）中RA患者的複發性感染比例；2. 探討指標感染的器官類別能否預測未來的嚴重感染。
方法：
如前所述，BSRBR-RA是一個前瞻性觀察性隊列。納入抗風濕藥物治療期間或停藥時間短於5個藥物半衰期時至少發作一次需要住院的嚴重感染患者。感染類別根據國際醫學用語詞典（MedDRA）分為7類，首次指標感染後14天內發生的感染為新事件。調整年齡、性別、病程、吸煙、基線DAS28評分和血清陽性等指標，用Cox比例風險模型計算並比較事件發生率。
結果：
見表。
研究共納入患者21943例，隨訪115423病人年，其中5365例至少報告一次嚴重感染。各組的年齡、病程、基線DAS28評分和HAQ評分具有可比性，比較基線時有既往感染的器官類別的組間差異。隊列特征見表。基線時首次嚴重感染的年發生率為4.6%（95%CI 4.5~4.7）。指標感染後，嚴重感染的年發生率為12.7%（95%CI 12.1～13.3）。最常見的是呼吸係統感染（事件占比41.4%）。指標感染的係統類別與複發性感染事件的風險有關。敗血症患者12個月內發生嚴重感染的風險最高，達19,7%。和呼吸道感染相比，敗血症患者1年內的複發性嚴重感染風險增加33%（HR 1.33，95%CI 1.01～1.76）。年齡增長是感染複發的重要預測因子。
結論：
既往有嚴重感染的RA患者的複發性感染風險升高。複發性感染事件的器官類別能否反映指標事件以及對感染後的生物治療策略有何影響仍待進一步研究。
原文
RECURRENT INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS, RESULTS FROM THE BSRBR
S.Subesinghe 1 , A.I. Rutherford 1 , R. Byng-Maddick 2, J.B. Galloway 1 .1 Rheumatology, King’s College London; 2 HomertonHospital, London, United
KingdomBackground: Rheumatoid arthritis (RA) patients have an increased susceptibilityto infection.
Objectives:
1.To establish the rate of recurrent infection in RA patients recruited to the British Society of Rheumatology Biologics Registry Rheumatoid Arthritis (BSRBR-RA).2.To establish whether the organ class of index infection predicted
future serious infection.
Methods:
The BSRBR-RA is a prospective observational cohort, previously described. Patients with at least one episode of serious infection requiring hospitalisation were included if they occurred whilst on anti-rheumatic drug therapy or within 5 drug half-lives of stopping. Infections were coded by MedDRA classification in to 7 categories. Infections occurring over 14 days after the first index infection were considered as new events. Event rates were calculated and compared using a Cox proportional hazards model with adjustments made for age, gender, disease duration, baseline DAS28 score, smoking status and seropositivity.
Results:
See Table 1.
In total, 21,943 subjects with 115,423 patient-years follow up were studied, 5365 subjects reported at least one serious infection. Comparing organ classes of prior
infection at baseline, each group had comparable age, disease duration, baseline DAS28 and HAQ scores. The cohort characteristics are tabulated. The baseline annual rate of first serious infection was 4.6% (95% CI 4.5–4.7). Following an index infection, the annual rate of serious infection was 12.7% (95% CI 12.1–13.3). Respiratory infections were the most common (41.4% of all events). The system class of index infection was associated with the risk of a recurrent event; subjects who experienced sepsis had the highest risk of subsequent serious infection within 12 months:19.7%. Compared to an index respiratory tract infection, sepsis conferred a 33% increased hazard for recurrent serious infection within a year (HR 1.33, 95% CI 1.01–1.76). Increasing age was a significant predictor of infection recurrence.
Conclusions:
There is a high risk of recurrent infection in RA patients with past serious infection. Work is ongoing to determine whether organ class of recurrent infection event mirrors index events and the impact of biologic treatment decisions following the index infection.
Disclosure of Interest:None declared
DOI: 10.1136/annrheumdis-2017-eular.1501
