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Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort

Rheumatoid arthritis (RA) develops after progressing through sequential ‘pre-RA’ phases. The mechanisms driving progression from one phase to the next remain poorly understood. This study examined the longitudinal rates of community and hospital infections in patients during sequential stages of pre...

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Autores principales: Porter, Duncan, Jain, Sahil, Qian, Evelyn, Morton, Fraser R, McInnes, Iain B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668306/
https://www.ncbi.nlm.nih.gov/pubmed/37996122
http://dx.doi.org/10.1136/rmdopen-2023-003224
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author Porter, Duncan
Jain, Sahil
Qian, Evelyn
Morton, Fraser R
McInnes, Iain B
author_facet Porter, Duncan
Jain, Sahil
Qian, Evelyn
Morton, Fraser R
McInnes, Iain B
author_sort Porter, Duncan
collection PubMed
description Rheumatoid arthritis (RA) develops after progressing through sequential ‘pre-RA’ phases. The mechanisms driving progression from one phase to the next remain poorly understood. This study examined the longitudinal rates of community and hospital infections in patients during sequential stages of pre-RA and early arthritis. METHODS: The Scottish Early RA inception cohort recruited patients with newly diagnosed RA. Incidences of infection were determined from community antibiotic prescriptions and serious infections were determined by hospital discharge coding. Dates of diagnosis and symptom onset allowed identification of asymptomatic/symptomatic pre-RA and early arthritis eras to analyse infection rates over time compared with age- and sex-matched controls. RESULTS: The incidence rate ratio (IRR) seen in the period 0–6 months prior to symptom onset was 1.28 (95% CI 1.15 to 1.42). In ‘symptomatic pre-RA’, the IRR was 1.33 (95% CI 1.18 to 1.49) which persisted into ‘early arthritis’. The rate of hospital admissions was numerically greater in ‘pre-RA’ and significantly greater in ‘early arthritis’ (IRR 1.82, 95% CI 1.32 to 2.46). CONCLUSION: Antibiotic risk is increased in patients with ‘pre-RA’ at least 6 months before symptoms develop, and this persists throughout the symptomatic pre-RA phase. Infections may be important in the mechanisms that drive progression to RA or be a manifestation of immune dysfunction (or both). These observations could inform safety and efficacy considerations for interventions in pre-RA to prevent progression. Patients with ‘pre-RA’ with recurrent antibiotic use may also be an identifiable ‘high risk’ group that could enrich the study population for intervention studies in pre-RA.
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spelling pubmed-106683062023-11-23 Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort Porter, Duncan Jain, Sahil Qian, Evelyn Morton, Fraser R McInnes, Iain B RMD Open Rheumatoid Arthritis Rheumatoid arthritis (RA) develops after progressing through sequential ‘pre-RA’ phases. The mechanisms driving progression from one phase to the next remain poorly understood. This study examined the longitudinal rates of community and hospital infections in patients during sequential stages of pre-RA and early arthritis. METHODS: The Scottish Early RA inception cohort recruited patients with newly diagnosed RA. Incidences of infection were determined from community antibiotic prescriptions and serious infections were determined by hospital discharge coding. Dates of diagnosis and symptom onset allowed identification of asymptomatic/symptomatic pre-RA and early arthritis eras to analyse infection rates over time compared with age- and sex-matched controls. RESULTS: The incidence rate ratio (IRR) seen in the period 0–6 months prior to symptom onset was 1.28 (95% CI 1.15 to 1.42). In ‘symptomatic pre-RA’, the IRR was 1.33 (95% CI 1.18 to 1.49) which persisted into ‘early arthritis’. The rate of hospital admissions was numerically greater in ‘pre-RA’ and significantly greater in ‘early arthritis’ (IRR 1.82, 95% CI 1.32 to 2.46). CONCLUSION: Antibiotic risk is increased in patients with ‘pre-RA’ at least 6 months before symptoms develop, and this persists throughout the symptomatic pre-RA phase. Infections may be important in the mechanisms that drive progression to RA or be a manifestation of immune dysfunction (or both). These observations could inform safety and efficacy considerations for interventions in pre-RA to prevent progression. Patients with ‘pre-RA’ with recurrent antibiotic use may also be an identifiable ‘high risk’ group that could enrich the study population for intervention studies in pre-RA. BMJ Publishing Group 2023-11-23 /pmc/articles/PMC10668306/ /pubmed/37996122 http://dx.doi.org/10.1136/rmdopen-2023-003224 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Rheumatoid Arthritis
Porter, Duncan
Jain, Sahil
Qian, Evelyn
Morton, Fraser R
McInnes, Iain B
Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort
title Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort
title_full Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort
title_fullStr Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort
title_full_unstemmed Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort
title_short Time-varying risks of infection in patients as they proceed through the phases of ‘pre-RA’: results from the Scottish Early RA inception cohort
title_sort time-varying risks of infection in patients as they proceed through the phases of ‘pre-ra’: results from the scottish early ra inception cohort
topic Rheumatoid Arthritis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668306/
https://www.ncbi.nlm.nih.gov/pubmed/37996122
http://dx.doi.org/10.1136/rmdopen-2023-003224
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