Risk of community-acquired pneumonia requiring hospitalization in patients with spondyloarthritis

Abstract

Aims: To compare the risk of community-acquired pneumonia (CAP) requiring hospitalization in spondyloarthritis (SpA) and non-specific back pain (NSBP), and to identify the risk factors for CAP in SpA. Methods: A total of 2984 patients with SpA from 11 rheumatology centers and 2526 patients with NSBP from orthopedic units were reviewed from the centralized electronic database in Hong Kong. Incidence of CAP requiring hospitalization and demographic data including age, gender, smoking and drinking status, use of sulfasalazine, individual biological-disease modifying anti-rheumatic drugs (DMARDs) used, micro-organisms, other immunosuppressants or immunosuppressive states, use of steroid for more than ½ year, and co-morbidities were identified. Risks of CAP in SpA were compared with those in NSBP using propensity score regression method. Multivariate Cox regression model was used to identify the risk factors in SpA. Results: CAP requiring hospitalization was found in 183 patients with SpA and 138 patients with NSBP. Increased risk for CAP was found in the following groups with SpA: all subgroups (hazard ratio (HR) 2.14, p < 0.001), without use of DMARDs (HR 2.64, p < 0.001), without psoriasis and not taking DMARDs (HR 2.38, p < 0.001). Infliximab (HR2.55, p = 0.04), smoking (HR 1.68, p = 0.003), comorbid psoriasis (HR 1.67, p = 0.003), and use of steroid for more than ½ year (HR 1.94, p = 0.003) were found to associate with CAP after adjustments for traditional risk factors. Conclusion: Risk of CAP is increased in patients with SpA. Our data favor universal influenza and pneumococcal vaccination programs in the population. Rheumatologists should also advise smoking cessation and avoid long term steroid therapy.

Risk of nonpulmonary infections requiring hospitalization in spondyloarthritis

“…Pharmacokinetically, high peak serum concentrations of infliximab up to 50 times the median trough level 41 also predisposes to infection 42 . Pneumonia, 11 tuberculosis, 10 and cutaneous herpes zoster 9 were also increased with infliximab therapy. Infliximab may have distinct immunosuppressive effects that increase infection risk.…”

“… 43 Steroid‐induced lymphopenia occurs via inhibition of T‐cell activation by inhibition of IL‐2, IL3, IL‐4, and IL‐6, 43 and suppression of dendritic cell maturation and function. 44 Long‐term steroid therapy has been shown to increase the risk of community‐acquired pneumonia 11 and tuberculosis 10 in SpA. Prolonged steroid therapy in SpA is not recommended 45 , 46 , 47 by international consensus guidelines.…”

“…On the other hand, a series of recent observational studies found that disease‐modifying antirheumatic drugs (DMARDs) and prolonged use of steroids were associated with herpes zoster, 9 and tuberculosis infection 10 . A recent multicenter cohort demonstrated an increased risk of community‐acquired pneumonia in SpA compared with nonspecific back pain (NSBP) 11 . Further investigation using real‐life data to delineate the risk of other nonpulmonary infections is therefore important for the prevention of infection and guiding public policy.…”

“… 10 A recent multicenter cohort demonstrated an increased risk of community‐acquired pneumonia in SpA compared with nonspecific back pain (NSBP). 11 Further investigation using real‐life data to delineate the risk of other nonpulmonary infections is therefore important for the prevention of infection and guiding public policy.…”

Pre-existing musculoskeletal pain and its association with mortality in newly diagnosed co-morbid conditions: an electronic health record cohort study

“…For example, OA [ 3–5 ], RA [ 6–8 ] and low back pain [ 9 , 10 ] have been shown to be associated with an increased risk of developing heart disease and stroke. Regional pain, such as back pain, PsA and PMR, have been linked to the onset of cancer [ 11–13 ], OA with dementia [ 14 ] and inflammatory musculoskeletal conditions with hospitalization for community-acquired pneumonia [ 15 ]. However, it is less clear whether musculoskeletal pain impacts the outcomes of these other conditions.…”