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Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome
OBJECTIVES: To determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management. METHODS: The Scottish Early Rheumatoid Arthritis inception cohort prospectively recru...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203094/ https://www.ncbi.nlm.nih.gov/pubmed/30402267 http://dx.doi.org/10.1136/rmdopen-2018-000739 |
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author | Fragoulis, George E Paterson, Caron Gilmour, Ashley Derakhshan, Mohammad H McInnes, Iain B Porter, Duncan Siebert, Stefan |
author_facet | Fragoulis, George E Paterson, Caron Gilmour, Ashley Derakhshan, Mohammad H McInnes, Iain B Porter, Duncan Siebert, Stefan |
author_sort | Fragoulis, George E |
collection | PubMed |
description | OBJECTIVES: To determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management. METHODS: The Scottish Early Rheumatoid Arthritis inception cohort prospectively recruited patients with newly diagnosed RA and followed them up every 6 months. Patients with RA who developed at least one episode of neutropaenia (grade 1: <2.0×10^9/L; grade 2: <1.5×10^9/L; grade 3: <1.0×10^9/L; grade 4: <0.5×10^9/L) were compared with those who did not. Comparisons were also made between patients who experienced one or more episodes of neutropaenia and between patients with different neutropaenia grades. RESULTS: 77 neutropaenia episodes were recorded in 58 of 771 (7.5%) patients with RA, who were followed up for a median (range) of 18 (6–48) months. Neutropaenia occurred at a median (range) of 12 (0–120) months after RA diagnosis. The majority had mild neutropaenia (grade 1: n=42; grade 2: n=14; grade 3: n=1; grade 4: n=1). Neutropaenia was transient (single episode) in the majority (44; 75.8%) of cases but led to treatment discontinuation in 14 (24.1%) patients. Patients who developed neutropaenia were more likely to be female (p=0.01) and non-smokers (p=0.007) and had lower baseline neutrophil levels (p<0.0001). Binomial regression analysis confirmed the latter (p<0.0001, B: −0.491) as neutropaenia predictor. The rate of infections did not differ between patients who developed neutropaenia and those who did not (p=0.878). CONCLUSION: Neutropaenia was a common finding in this cohort. It was usually mild, transient and not associated with increased infection rates. Neutropaenia occurrence was associated with non-smoking, female gender and lower baseline neutrophil levels. |
format | Online Article Text |
id | pubmed-6203094 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-62030942018-11-06 Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome Fragoulis, George E Paterson, Caron Gilmour, Ashley Derakhshan, Mohammad H McInnes, Iain B Porter, Duncan Siebert, Stefan RMD Open Rheumatoid Arthritis OBJECTIVES: To determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management. METHODS: The Scottish Early Rheumatoid Arthritis inception cohort prospectively recruited patients with newly diagnosed RA and followed them up every 6 months. Patients with RA who developed at least one episode of neutropaenia (grade 1: <2.0×10^9/L; grade 2: <1.5×10^9/L; grade 3: <1.0×10^9/L; grade 4: <0.5×10^9/L) were compared with those who did not. Comparisons were also made between patients who experienced one or more episodes of neutropaenia and between patients with different neutropaenia grades. RESULTS: 77 neutropaenia episodes were recorded in 58 of 771 (7.5%) patients with RA, who were followed up for a median (range) of 18 (6–48) months. Neutropaenia occurred at a median (range) of 12 (0–120) months after RA diagnosis. The majority had mild neutropaenia (grade 1: n=42; grade 2: n=14; grade 3: n=1; grade 4: n=1). Neutropaenia was transient (single episode) in the majority (44; 75.8%) of cases but led to treatment discontinuation in 14 (24.1%) patients. Patients who developed neutropaenia were more likely to be female (p=0.01) and non-smokers (p=0.007) and had lower baseline neutrophil levels (p<0.0001). Binomial regression analysis confirmed the latter (p<0.0001, B: −0.491) as neutropaenia predictor. The rate of infections did not differ between patients who developed neutropaenia and those who did not (p=0.878). CONCLUSION: Neutropaenia was a common finding in this cohort. It was usually mild, transient and not associated with increased infection rates. Neutropaenia occurrence was associated with non-smoking, female gender and lower baseline neutrophil levels. BMJ Publishing Group 2018-10-08 /pmc/articles/PMC6203094/ /pubmed/30402267 http://dx.doi.org/10.1136/rmdopen-2018-000739 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Rheumatoid Arthritis Fragoulis, George E Paterson, Caron Gilmour, Ashley Derakhshan, Mohammad H McInnes, Iain B Porter, Duncan Siebert, Stefan Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome |
title | Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome |
title_full | Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome |
title_fullStr | Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome |
title_full_unstemmed | Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome |
title_short | Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome |
title_sort | neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome |
topic | Rheumatoid Arthritis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203094/ https://www.ncbi.nlm.nih.gov/pubmed/30402267 http://dx.doi.org/10.1136/rmdopen-2018-000739 |
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