Friday, 19 Jul 2019

You are here

Steroids in GCA and PMR Increase Infectious Risk

A large study of UK family practice patients shows that polymyalgia rheumatica (PMR) or giant cell arteritis (GCA) patients treated with glucocorticoids are at an increased risk of bacterial, viral, parasitic and fungal infection, even at daily doses of less than 5 mg prednisolone.

A retrospective, medical record review of 389 UK family practices identified 39,938 patients between 1998–2017, estimated the first occurring infection and related that to their dose of glucocorticoids.

Overall, over half (2234 or 55.7%) of PMR and GCA had at least 1 infection over a 4.8 year follow-up period.  Hospitalization was required in half of these (5937 or 26.7%) and 7.3% died within 7 days of diagnosis.

Time related, all cause risks for infection were:

  • at 1 year - 18.3% (17.9%–18.7%)
  • at 5 years - 54.7% (54.1%–55.2%)
  • at 10 years 76.9% (76.2%–77.5%)

The most common were lower respiratory tract infections, conjunctivitis and herpes zoster.

For each 5 mg prednisolone-equivalent daily dose increase there was a corresponding increase in infection risk.

Glucocorticoid exposure increased the risk of fungal inection (HR 1.48;1.39–1.57) and bacterial infections (HR 1.70;1.60–1.80). Similar increases were seen for viral and parasitic infections, irrespective of patient age, duration of underlying chronic disease and baseline vaccination status.

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Cardiovascular Disease Increased in Hospitalized Lupus Patients

Systemic lupus erythematosus (SLE) patients who are hospitalized have an increased prevalence of atherosclerotic cardiovascular disease (ASCVD) and its individual phenotypes of coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease. 

Pregnancy Outcomes Improve in Lupus

Pregnancy for patients with lupus has long been considered high risk and associated with both medical and obstetric complications, but outcomes have improved over the last 2 decades and continue to improve. The large decline in in-hospital maternal mortality was greater for lupus pregnancies than for non-lupus pregnancies. Findings from a retrospective cohort study are published in Annals of Internal Medicine.

Blinded by the Use of Antimalarials in Lupus?

Editor's note: July 1 - 5, RheumNow is running the best of EULAR 2019 meeting. Hydroxychloroquine (HCQ) will decrease SLE flares improve lipids, decrease clots, improve survival, augment the response to mycophenolate and are the cornerstone of treatment as per the SLE EULAR guidelines presented at EULAR 2019 in Madrid and also published in ARD. But, if you prescribe them long term, will your patients go blind?

Disparities in Lupus Survival

MMWR has published the outcomes from the Georgia Lupus Registry between 2002 and 2016, finding that black women were not only more likely to die from lupus than white lupus patients; but they died on average 13 years earlier (mean age 51.8 and 52.3 years, respectively) than whites (mean age 64.4 and 65.0 years, respectively). Black women with lupus were 3.34 times more likely to die than black women in the general population, while white women with lupus were 2.43 times more likely to die than white women in the general population. None of the white women with lupus died within 5 years of diagnosis, while mortality was elevated for black women from the date of diagnosis on.

DMARD Success in Myositis-Related Interstitial Lung Disease

It is estimated that up to 50% of patients with idiopathic inflammatory myopathy will be complicated by interstitial lung disease, and having ILD may impart a poor prognosis. A recent review of the Johns Hopkins myositis-related ILD cohort has shown that azathioprine and mycophenolate mofetil use is associated improved lung function and less prednisone use.