Risk of septic arthritis in patients with rheumatoid arthritis and the effect of anti-TNF therapy: results from the British Society for Rheumatology Biologics Register

• Published in: Annals of the rheumatic diseases Vol. 70; no. 10; pp. 1810 - 1814
• Main Authors: Galloway, J B, Hyrich, K L, Mercer, L K, Dixon, W G, Ustianowski, A P, Helbert, M, Watson, K D, Lunt, M, Symmons, D P M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.10.2011; BMJ Publishing Group; BMJ Publishing Group LTD; BMJ Group
• Series: Extended report
• Subjects: Adult; Aged; Antibiotics; Antirheumatic Agents - adverse effects; Arthritis, Infectious - complications; Arthritis, Infectious - epidemiology; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - epidemiology; Biological and medical sciences; Biological products; Clinical and Epidemiological Research; Diseases of the osteoarticular system; Epidemiologic Methods; Female; Humans; Immunosuppressive Agents - adverse effects; Infections; Inflammatory joint diseases; Joint Prosthesis - adverse effects; Joint replacement surgery; Joint surgery; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Opportunistic Infections - complications; Opportunistic Infections - epidemiology; Pathogens; Patients; Prostheses; Prosthesis-Related Infections - complications; Prosthesis-Related Infections - epidemiology; Rheumatoid arthritis; Rheumatology; Society; TNF inhibitors; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; United Kingdom - epidemiology; United Kingdom > UK; Human; Immunopathology; Diseases of the osteoarticular system; Rheumatology; Anti-TNF; Autoimmune disease; Inflammatory joint disease; Arthritis; Infection; Chronic; Treatment; Rheumatoid arthritis; Risk factor
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2011.152769

Objectives To evaluate the risk of septic arthritis (SA) in patients with rheumatoid arthritis (RA) treated with anti-tumour necrosis factor (TNF) therapy. Methods Using data from the British Society for Rheumatology Biologics Register, a prospective observational study, the authors compared the risk of SA between 11 881 anti-TNF-treated and 3673 non-biological disease-modifying antirheumatic drug (nbDMARD)-treated patients. Results 199 patients had at least one episode of SA (anti-TNF: 179, nbDMARD: 20). Incidence rates were: anti-TNF 4.2/1000 patient years (pyrs) follow-up (95% CI 3.6 to 4.8), nbDMARD 1.8/1000 pyrs (95% CI 1.1 to 2.7). The adjusted HR for SA in the anti-TNF cohort was 2.3 (95% CI 1.2 to 4.4). The risk did not differ significantly between the three agents: adalimumab, etanercept and infliximab. The risk was highest in the early months of therapy. The patterns of reported organisms differed in the anti-TNF cohort. Prior joint replacement surgery was a risk factor for SA in all patients. The rate of postoperative joint infection (within 90 days of surgery) was 0.7%. This risk was not significantly influenced by anti-TNF therapy. Conclusions Anti-TNF therapy use in RA is associated with a doubling in the risk of SA. Physicians and surgeons assessing the RA patient should be aware of this potentially life-threatening complication.