类风湿性关节炎患者呼吸道感染发病率高—又是激素惹的祸？

hxq2007

Respiratory Infections Common in Rheumatoid Arthritis Patients

NEW YORK (Reuters Health) Oct 26 - Acute lower respiratory tract infections are common in patients with rheumatoid arthritis, according to results of a study published in the September issue of the Journal of Rheumatology. Respiratory infections in this population carry a high mortality.

\"Rheumatoid arthritis...shortens life expectancy compared to a control population, and excess deaths are largely caused by accelerated vascular events and an increased propensity to infection, much of which is of respiratory origin,\" Dr. Clive A. Kelly and colleagues from Queen Elizabeth Hospital, Gateshead, UK, write.

\"The relationship between infection and RA (cause or effect?) has been questioned and the relative contributions to respiratory infection in RA of the disease itself and the treatment administered to suppress it are unclear.\"

The researchers examined whether the development of lower respiratory tract infection (LRTI) in patients with rheumatoid arthritis (RA) is the result of their use of the drugs used to treat the RA or the inflammatory arthritis itself.

In a population of 1,522 RA patients seen at the researchers' institution over a 12-month period, 36 patients were admitted for 43 acute respiratory episodes. A detailed drug history and data on clinical outcome were collected for each case. The team collected and analyzed premorbid illnesses and admission data to evaluate the influence of oral steroids and disease modifying antirheumatic drugs (DMARD) on outcome.

The overall annual incidence of LRTI in RA patients was 2.3%. Eight patients died from LRTI, for a mortality rate of 22.2%. Risk factors that predicted LRTI in this population included older age and male sex. An association was observed between oral steroid therapy and not taking DMARDs and an increased risk of hospital admission with LRTI. The authors report that there was a trend toward increased mortality in men and in those with long disease duration.

The researchers note that they have changed their clinical practice as a result of these findings. \"In addition to initiating DMARDs early in all patients with RA, we actively pursue annual vaccination against influenza and Pneumovax injections every 5 years in all patients, independent of their treatment,\" Dr. Kelly and colleagues write.

\"Older patients with long disease duration are now actively encouraged to commence DMARD therapy rather than oral steroids, although drug selection may be influenced by the presence of coexistent cardiac or pulmonary disease.\"

J Rheumatol 2007;34:1832-1836.