Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome

Abstract

ObjectivesTo 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.MethodsThe 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.Results77 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).ConclusionNeutropaenia 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.

Autoimmune disease in patients with diffuse large B-cell lymphoma: occurrence and impact on outcome

“…One clinical problem which potentially may influence prognosis in lymphoma is treatment-related neutropenic fever [34][35][36][37]. It is well known that patients with AIDs such as RA and SLE have an increased risk of infections [34,35] and neutropenia may be a manifestation of some of the AIDs [36][37][38], but it is not known if neutropenic fever is a more common problem in DLBCL patients with a concomitant AID than in DLBCL patients in general.…”

Prognostic factors for liver, blood and kidney adverse events from glucocorticoid sparing immune-suppressing drugs in immune-mediated inflammatory diseases: a prognostic systematic review

“…For thiopurines there were nine retrospective cohort studies, 45 48–50 52 54 56–58 six case–control studies, 47 55 59–62 two prospective cohort studies, 46 53 and one RCT. 51 Other conventional DMARDs were studied in 13 retrospective cohort studies, 18 20 21 24 25 27 29–32 34 35 37 39 40 44 2 case–control studies, 23 36 7 prospective cohort studies, 19 33 38 41–43 1 RCT reanalysed as a cohort 22 and 2 additional RCTs. 26 28 Of those studies on MTX that reported concomitant medication, all participants were taking folic acid in six studies, 20 22 31 38 39 41 42 while some but not all participants were taking folic acid in five further studies.…”

“… 67 There was moderate-quality evidence that leucopaenia or low neutrophil count at baseline were associated with increased risk of neutropenia in those prescribed conventional DMARDs +/− biologics. 23 …”

How do multiple long-term conditions impact on the cost-of-illness in early rheumatoid arthritis?

“…As SERA is an inception cohort, all participants started on conventional DMARDs 21 prescribed in primary care, with only 8% of participants receiving biologics after a mean follow-up period of 18 months. 39 This could lead to an underestimation of absolute costs across LTC groups since biologics are much more expensive than conventional DMARDs.…”

“…In line with national guidelines and standard clinical practice, patients with RA have to fail at least two conventional synthetic DMARDs before starting a biological DMARD. As SERA is an inception cohort, all participants started on conventional DMARDs21 prescribed in primary care, with only 8% of participants receiving biologics after a mean follow-up period of 18 months 39. This could lead to an underestimation of absolute costs across LTC groups since biologics are much more expensive than conventional DMARDs.…”