Influence of disease duration and socioeconomic factors on the prevalence of infection and hospitalization in rheumatoid arthritis: KRAC study.

Authors:
Vineeta Shobha
Vineeta Shobha
St. John's Medical College Hospital
India
Balebail G Dharmanand
Balebail G Dharmanand
SAKRA Hospital
Ramesh Jois
Ramesh Jois
The Medical School
United Kingdom
Sharath Kumar
Sharath Kumar
Amrita Institute of Medical Sciences
India
Kurugodu Mathada Mahendranath
Kurugodu Mathada Mahendranath
Samarpan Health Centre
Vikram Haridas
Vikram Haridas
Sushruta Multispecialty Hospital and Research Centre Pvt. Ltd.
Shiva Prasad
Shiva Prasad
Sanjay Gandhi Postgraduate Institute of Medical Sciences
India

Int J Rheum Dis 2019 Apr 11. Epub 2019 Apr 11.

ChanRe Rheumatology and Immunology Centre, Bangalore, India.

Aim: The use of healthcare resources by rheumatoid arthritis (RA) patients can be related to the presence of disease, comorbid conditions, use of steroids, and the combined use of immunosuppressants. This study evaluated the risk factors associated with infection and hospitalization in RA.

Methods: This multicenter, cross-sectional study enrolled 3247 RA subjects fulfilling the 2010 American College of Rheumatology/European League Against Rheumatism criteria to examine the prevalence of hospitalization and episodes of documentable non-tubercular infections as a part of the "Karnataka rheumatoid arthritis comorbidity" study (KRAC). The study included 2081 subjects and 1166 were excluded due to incomplete data. Demographic, clinical and treatment variables were collected, and the events related to infections and hospitalization were extracted from the medical records. Comparative analysis and multivariate logistic regression were performed.

Results: Around 22% of the subjects had hospitalizations and 2.9% had infections. Infections were pertaining to dental (1.3%), urinary tract (1.6%) and candidiasis (0.2%). Skin- and soft tissue-related infections were found in 1.8% and 0.3% of patients, respectively. Increased need of hospitalization in RA patients was associated with advanced age (≥60 years), lower education, family income, and longer duration of RA. Presence of comorbidity, usage of three or more disease-modifying anti-rheumatic drugs (DMARDs) and family income influenced the likelihood of infection. Dental infections were less likely in working subjects and more likely in patients with increased disease duration, higher family income, comorbidities and those between the age group 40-59 years. Urinary tract infection was associated with DMARD usage.

Conclusion: Patient-specific risk factors should be considered to improve treatment strategies and to reduce the risk of infection and hospitalization in RA patients.

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http://dx.doi.org/10.1111/1756-185X.13562DOI Listing

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April 2019
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