Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment
Authors
Beukelman, TimothyXie, Fenglong
Chen, Lang
Baddley, John W.
Delzell, Elizabeth
Grijalva, Carlos G.
Lewis, James D.
Ouellet-Hellstrom, Rita
Patkar, Nivedita M.
Saag, Kenneth G.
Winthrop, Kevin L.
Curtis, Jeffrey R.
SABER Collaboration
Harrold, Leslie R.
UMass Chan Affiliations
Department of Medicine, Division of RheumatologyMeyers Primary Care Institute
Document Type
Journal ArticlePublication Date
2012-08-01Keywords
AdolescentArthritis, Juvenile Rheumatoid
Bacterial Infections
Child
Child, Preschool
Cohort Studies
Comorbidity
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Glucocorticoids
Hospitalization
Humans
Incidence
Male
Medicaid
Methotrexate
Prednisone
Retrospective Studies
Tumor Necrosis Factor-alpha
United States
Musculoskeletal Diseases
Rheumatology
Metadata
Show full item recordAbstract
OBJECTIVE: To compare the incidence of hospitalized bacterial infections among children with and children without juvenile idiopathic arthritis (JIA) and to examine the effects of selected medications. METHODS: Using national Medicaid data from 2000 through 2005, we identified a cohort of children with JIA and a comparator cohort of children with attention deficit hyperactivity disorder (ADHD). Exposures to methotrexate (MTX), TNF inhibitors, and oral glucocorticoids (GCs) were determined using pharmacy claims. Patients hospitalized with bacterial infections were identified using coded discharge diagnoses. We calculated adjusted hazard ratios (HR(adj) ) to compare infection incidence rates while adjusting for relevant covariates. RESULTS: We identified 8,479 JIA patients with 13,003 person-years of followup; 36% took MTX and 16% took TNF inhibitors. Compared with ADHD patients, JIA patients who were not currently taking MTX or TNF inhibitors had an increased rate of infection (HR(adj) 2.0 [95% confidence interval (95% CI) 1.5, 2.5]). Among JIA patients not receiving TNF inhibitor therapy, MTX users had a similar rate of infection as those not currently taking MTX (HR(adj) 1.2 [95% CI 0.9, 1.7]). TNF inhibitor use (irrespective of MTX) resulted in a similar rate of infection as use of MTX without a TNF inhibitor (HR(adj) 1.2 [95% CI 0.8, 1.8]). Use of high-dose GCs (>/=10 mg/day of prednisone or equivalent) increased the rate of infection as compared with no GC use, after adjustment for MTX and TNF inhibitor use (HR(adj) 3.1 [95% CI 2.0, 4.7]). CONCLUSION: Children with JIA had an increased rate of infection compared to children with ADHD. Among children with JIA, the rate of infection was not increased with MTX or TNF inhibitor use, but was significantly increased with high-dose GC use.Source
Arthritis Rheum. 2012 Aug;64(8):2773-80. doi: 10.1002/art.34458. Link to article on publisher's site
DOI
10.1002/art.34458Permanent Link to this Item
http://hdl.handle.net/20.500.14038/37201PubMed ID
22569881Notes
Leslie Harrold is a member of the SABER (Safety Assessment of Biological Therapeutics) Collaboration.
Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1002/art.34458