Respiratory infections common in people with RA

NEW YORK (Reuters Health) - Research shows that acute lower respiratory tract infections are common in people with rheumatoid arthritis (RA) and they carry a high mortality rate in this population.

"The relationship between infection and RA (cause or effect?) has been questioned and the relative contributions to respiratory infection in RA of the disease itself and the treatment administered to suppress it are unclear," Dr. Clive A. Kelly and colleagues from Queen Elizabeth Hospital, Gateshead, UK, note in a report in the Journal of Rheumatology.

With the aim of determining whether the development of lower respiratory tract infection in patients with RA is the result of their use of drugs used to treat the RA or the inflammatory arthritis itself, the authors identified all episodes of acute lower respiratory tract infection in their hospital over a 12-month period.

A detailed drug history and data on clinical outcome were collected for each case. The team collected and analyzed premorbid illnesses and admission data to evaluate the influence of oral steroids and disease modifying antirheumatic drugs (DMARD) on outcome.

The overall annual incidence of lower respiratory tract infection in RA patients was 2.3 percent. Eight patients died from respiratory infection, for a mortality rate of 22.2 percent.

Taking oral steroids and not taking DMARDs was associated with an increased risk of hospital admission for respiratory infection, the authors found. Older age and male sex were also risk factors for lower respiratory tract infection in this population.

Based on their findings, Kelly and colleagues say they have made some changes in their clinical practice: "In addition to initiating DMARDs early in all patients with RA, we actively pursue annual vaccination against influenza and pneumovax injections every 5 years in all patients, independent of their treatment," they write.

They also "actively encourage" older patients with long-standing RA to start DMARD therapy rather than oral steroids, although drug selection may be influenced by the presence of coexistent heart and lung disease.

SOURCE: Journal of Rheumatology, September 2007.