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.

Galloway JB, Hyrich KL, Mercer LK, Dixon WG, Ustianowski AP, Helbert M, Watson KD, Lunt M, Symmons DP; ; on behalf of the BSR Biologics Register.

Source

1Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.

Abstract

OBJECTIVES:

To evaluate the risk of septic arthritis (SA) in patients with rheumatoid arthritis (RA) treated with anti-tumour necrosis factor (TNF) therapy.

METHODS:

Using 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.

RESULTS:

199 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.

CONCLUSIONS:

Anti-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.

PMID: 21784730

BSRBR数据提示TNF拮抗剂可能增加感染性关节炎发生风险

Galloway JB, et al. Ann Rheum Dis. 2011 Jul 21. 提前在线.

目的: 评估TNF拮抗剂治疗RA患者时的感染性关节炎(SA)发生风险。

方法: 采用来自英国风湿病学会生物制剂治疗患者注册登记数据库(BSRBR)的前瞻性研究数据，研究者比较了11881例抗TNF治疗患者以及3673例传统DMARDs治疗患者的SA发生风险。

结果: 199例患者至少发生1起SA（抗TNF: 传统DMARDs=179: 20）。抗TNF治疗组的SA发生率为4.2/1000病人年(pys)(95%CI: 3.6 - 4.8)，传统DMARDs的SA发生发生率为1.8/1000pys(95%: 1.1 - 2.7)。抗TNF队列的校正风险比(HR)为2.3(95%CI: 1.2 - 4.4)。三种TNF拮抗剂即阿达木、依那西普和英夫利昔之间的SA发生风险无显著差异。治疗头几个月的感染风险最高。病人报告的感染微生物在不同TNF拮抗剂之间有差别。用药之前做过关节置换术是所有病人的风险因素。术后关节感染发生率为0.7%(通常发生于术后90天内)。抗TNF治疗并没有显著影响SA发生风险。

结论: 接受抗TNF治疗的RA患者发生感染性关节炎的风险增加2倍。内科以及外科医生在评估RA病人时应了解这种危及生命的潜在并发症。