Rheumatoid arthritis: glucocorticoids up infection risk after joint replacement

  • George MD & al.
  • Ann Intern Med
  • 21 May 2019

  • International Clinical Digest
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Takeaway

  • Glucocorticoid usage among patients with rheumatoid arthritis (RA) is strongly associated with postarthroplasty infection risk, even at modest doses.
  • Biologics usage is associated with generally lower risks, and risks are similar across biologics.

Why this matters

  • Hip and knee arthroplasty are common among patients with RA.
  • Authors recommend limiting perioperative use of glucocorticoids.

Study design

  • Retrospective cohort of patients with RA undergoing knee or hip arthroplasty (primary or revision), using biologics (n=9911) or glucocorticoids (n=about 6500) before surgery, in the Medicare and Truven MarketScan databases.
  • Primary outcomes were cumulative incidence of hospitalized infections within 30 days and prosthetic joint infection (PJI) within 1 year of total knee or hip arthroplasty, according to propensity-adjusted analyses using inverse-probability weights.
  • Funding: NIH; Bristol-Myers Squibb; others.

Key results

  • Biologics:
    • Compared with 8.16% predicted risk for hospitalized infection with abatacept, predicted cumulative risk from propensity-weighted models ranged from 6.87% to 8.90% with other biologics (adalimumab, etanercept, infliximab, rituximab, and tocilizumab).
    • Compared with 2.14% predicted risk for PJI with abatacept, predicted cumulative incidence ranged from 0.35% to 3.67% with other biologics.
  • Glucocorticoids:
    • Compared with nonusers, there was a dose-dependent predicted increased cumulative risk for hospitalized infection and PJI, with highest risk at doses >10 mg/day (13.25% and 3.83%, respectively).

Limitations

  • Potential residual confounding.