title: The association between serious infection and disease outcome in patients with rheumatoid arthritis.
abstract: The purpose of this study was to study the association between the past history of serious infection (SI) that required hospitalization and the current disease status of rheumatoid arthritis (RA), including disease activity, physical disability, and radiological joint destruction. The history of hospitalized infection was retrospectively analyzed in a cohort of 370 RA patients. The patients were divided into three groups based on the number of SI events (SI = 0, SI = 1, SI ≥ 2). Disease activity score using 28 joints (DAS28), Health Assessment Questionnaire (HAQ), and modified total sharp score (mTSS) adjusted after disease duration or other confounding factors were compared among the three groups. Among the study patients, 7.3% (27 patients) experienced single SI (SI = 1) and 2.1% (8 patients) experienced multiple SI events (SI ≥ 2). Compared with patients with no SI (SI = 0), patients with SI (SI = 1 or SI ≥ 2) had increased pulmonary and autoimmune comorbidities and were more frequently treated with glucocorticoids. DAS28 was not different among the groups, while HAQ and mTSS increased with the number of SI. After adjustment, only mTSS adjusted after disease duration remained statistically significantly different between patients with SI = 0 and SI ≥ 2 (p = 0.030). Multiple SI events are associated with advanced physical disability and radiological joint destruction in patients with RA.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Iguchi-Hashimoto
authors.affiliation: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan. mohashim@kuhp.kyoto-u.ac.jp.
authors.forename: Motomu
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of Endocrinology and Metabolism, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Hamaguchi
authors.affiliation: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Moritoshi
authors.initials: M
authors.lastname: Furu
authors.affiliation: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.|Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Ito
authors.affiliation: Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yamakawa
authors.affiliation: Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Chikashi
authors.initials: C
authors.lastname: Terao
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Graduate School of Medicine, Osaka University, Osaka, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.|Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Yamamoto
authors.affiliation: Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ohmura
authors.affiliation: Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tsuneyo
authors.initials: T
authors.lastname: Mimori
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids
keywords: Biological disease modifying anti-rheumatic drugs; Comorbidities; Glucocorticoids; Rheumatoid arthritis; Serious infection