Risk of infection in patients with early inflammatory arthritis: results from a large UK prospective observational cohort study

TY - JOUR

T1 - Risk of infection in patients with early inflammatory arthritis

T2 - results from a large UK prospective observational cohort study

AU - Adas, Maryam A

AU - Bechman, Katie

AU - Russell, Mark D

AU - Allen, Victoria

AU - Patel, Samir

AU - Gibson, Mark

AU - Karafotias, Ioasaf

AU - Biddle, Kathryn

AU - Zuckerman, Benjamin

AU - Song, Kaiyang

AU - Nagra, Deepak

AU - Alveyn, Edward

AU - Mahendrakar, Suma

AU - Nursoy, Meryem

AU - Atzeni, Fabiola

AU - Gallagher, Sarah

AU - Price, Elizabeth

AU - Garton, Mark

AU - Rutherford, Andrew

AU - Cope, Andrew P

AU - Norton, Sam

AU - Galloway, James B

N1 - Publisher Copyright: © 2025 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology.

PY - 2025/11/30

Y1 - 2025/11/30

N2 - Objective To identify risk of serious infections (SI) according to initial conventional synthetic DMARDs (csDMARD) and CS, in patients recruited to the National Early Inflammatory Arthritis Audit. Methods An observational cohort study was used, including adults in England and Wales with new diagnoses of RA between 2018 and 2023. The main outcome was SI events, defined as infections requiring hospitalization/or resulting in death. Secondary analyses evaluated SI-related mortality alone. Hazard ratios (HR) were calculated using cox proportional hazards models. Primary predictor was initial treatment strategy, with confounder adjustments. Results A total of 17 472 patients were included, of whom 10 997 were on MTX-based strategies, 4540 on other csDMARDs and 13 680 received CS. There were 1307 SI events, corresponding to incidence rates (IR) per 100 person-years of 3.02 (95% CI 2.86-3.19) and 311 cases of SI-related mortality (IR 0.69, 95% CI 0.61-0.77). MTX-based strategies were associated with reduced risk of SI events compared with other csDMARDs (adjusted HR 0.72, 95% CI 0.63-0.82). In unadjusted models, CS was associated with higher risk of SI events, but in adjusted models this association was no longer significant (adjusted HR 0.99, 95% CI 0.87-1.12). Increasing age, being a current/or ex-smoker (relative to non-smoker), having a comorbidity, being seropositive and having high DAS based on 28 joint count (DAS28) were all associated with increased incidence of SI. One unit increase in baseline DAS28 increases the risk of SI event by 10%. ConclusionMTX-based regimens associated with a reduced risk of SI compared with other strategies. Patient-level and disease-related factors at diagnosis are important predictors of SI in individuals with new RA.

AB - Objective To identify risk of serious infections (SI) according to initial conventional synthetic DMARDs (csDMARD) and CS, in patients recruited to the National Early Inflammatory Arthritis Audit. Methods An observational cohort study was used, including adults in England and Wales with new diagnoses of RA between 2018 and 2023. The main outcome was SI events, defined as infections requiring hospitalization/or resulting in death. Secondary analyses evaluated SI-related mortality alone. Hazard ratios (HR) were calculated using cox proportional hazards models. Primary predictor was initial treatment strategy, with confounder adjustments. Results A total of 17 472 patients were included, of whom 10 997 were on MTX-based strategies, 4540 on other csDMARDs and 13 680 received CS. There were 1307 SI events, corresponding to incidence rates (IR) per 100 person-years of 3.02 (95% CI 2.86-3.19) and 311 cases of SI-related mortality (IR 0.69, 95% CI 0.61-0.77). MTX-based strategies were associated with reduced risk of SI events compared with other csDMARDs (adjusted HR 0.72, 95% CI 0.63-0.82). In unadjusted models, CS was associated with higher risk of SI events, but in adjusted models this association was no longer significant (adjusted HR 0.99, 95% CI 0.87-1.12). Increasing age, being a current/or ex-smoker (relative to non-smoker), having a comorbidity, being seropositive and having high DAS based on 28 joint count (DAS28) were all associated with increased incidence of SI. One unit increase in baseline DAS28 increases the risk of SI event by 10%. ConclusionMTX-based regimens associated with a reduced risk of SI compared with other strategies. Patient-level and disease-related factors at diagnosis are important predictors of SI in individuals with new RA.

UR - https://www.scopus.com/pages/publications/105021013000

U2 - 10.1093/rheumatology/keaf312

DO - 10.1093/rheumatology/keaf312

M3 - Article

C2 - 40471746

SN - 1462-0324

VL - 64

SP - 5647

EP - 5655

JO - Rheumatology

JF - Rheumatology

IS - 11

ER -