Association Between the Number of Comorbidities and the Risk of a Serious Infection in Rheumatoid Arthritis Treated by a First Biologic Agent

Objective.Previous studies combining biologic disease-modifying antirheumatic drugs (bDMARD) to treat rheumatoid arthritis (RA) have shown an increased risk of infection. However, the risk of infection with concurrent use of denosumab, a biologic agent for the treatment of osteoporosis, and a bDMARD remains unclear. Here, we evaluated the incidence of serious and opportunistic infections in patients treated concurrently with denosumab and a bDMARD and patients treated with a bDMARD alone.Methods.A chart review of patients with RA from 2 Canadian rheumatology practices between July 1, 2010, and July 31, 2014, identified 2 groups of patients: those taking denosumab and a bDMARD concurrently (concurrent group) and those taking only a bDMARD (biologic-alone group). Patients were followed from the time of initiation of denosumab, or a matched index date for the biologic-alone group, to the end of the study or loss to followup. Instances of serious or opportunistic infections were recorded.Results.A total of 308 patients (n = 102 for the concurrent group and n = 206 for the biologic-alone group) were evaluated. Within the concurrent group, 3 serious infection events occurred. Within the biologic-alone group, 4 serious infection events and 1 opportunistic infection event occurred. In both groups, all patients with serious or opportunistic infection recovered, and there were no instances of death during the study period.Conclusion.This study demonstrated a low occurrence of serious and opportunistic infections in patients with RA taking bDMARD, including patients with concurrent denosumab use.

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AB0224 ASSOCIATIONS BETWEEN JOINT REPLACEMENT HISTORY AND CYCLIC CITRULLINATED PEPTIDE ANTIBODY TITERS IN RHEUMATOID ARTHRITIS PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3981 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1412.2-1412

Author(s):

M. Sato ◽

M. Takemura

Keyword(s):

Rheumatoid Arthritis ◽

Joint Replacement ◽

Disease Duration ◽

Certolizumab Pegol ◽

Biologic Agent ◽

Cyclic Citrullinated Peptide ◽

Replacement Procedure ◽

Antibody Titers ◽

Age Range ◽

Citrullinated Peptide

Background:High titers of cyclic citrullinated peptide antibodies (anti-CCP) are predictive of poor prognosis in the treatment of rheumatoid arthritis (RA). The 2010 ACR/EULAR classification criteria for early RA assign a high point value to cases having highly positive anti-CCP titers. Previous reports have claimed that osteoarthritic damage is more severe and advanced in RA patients who test positive for anti-CCP than in their negative counterparts.Objectives:To retrospectively investigate whether anti-CCP titers were associated with the extent of osteoarthritic damage in RA patients treated at our institution.Methods:Data were analyzed for 422 RA patients who received biologic agents due to resistance to methotrexate or other conventional antirheumatic drugs. Associations were explored between joint replacement history-i.e. total knee replacement (TKR), total hip replacement (THR), or lack thereof—and anti-CCP positivity rates and titers.Results:The sample consisted of 90 men and 332 women. On average, patients were put on biologics at 58.6 years of age (range: 22–85), and had a disease duration of 9.3 years. The first biologic agent chosen was infliximab (IFX) in 154 cases, etanercept (ETN) in 76, adalimumab (ADA) in 61, tocilizumab (TCZ) in 70, abatacept (ABT) in 41, golimumab (GLM) in 18, and certolizumab pegol (CZP) in 2. In total, 331/422 patients (78.4%) tested positive for anti-CCP. TKR was performed in 46 cases (M:F ratio: 7:39, mean age: 64.7 y, mean disease duration: 15.1 y), of which 46 were positive for anti-CCP (100%). THR was performed in 18 cases (M:F ratio: 2:16, mean age: 62.3 y, mean disease duration: 18.5 y), of which 17 were positive for anti-CCP (94.4%). The mean anti-CCP titer among all positive patients (n=331) was 152.9 IU/ml. This value was significantly higher in patients who underwent either joint replacement procedure than those who did not (215.4 v. 142.8 IU/ml, p<0.0005).Conclusion:With one exception, all RA patients who underwent joint replacement were positive for anti-CCP, and their titers were higher than non-surgical cases. Practitioners should be aware of this trend, and pay attention to the progression of damage in the knee and hip joints when treating RA patients with high anti-CCP titers.Disclosure of Interests:None declared

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Impact of Sustained Remission on the Risk of Serious Infection in Patients With Rheumatoid Arthritis

Arthritis Care & Research ◽

10.1002/acr.23426 ◽

2018 ◽

Vol 70 (5) ◽

pp. 679-684 ◽

Cited By ~ 11

Author(s):

Neil A. Accortt ◽

Tamara Lesperance ◽

Mei Liu ◽

Sabrina Rebello ◽

Mona Trivedi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Sustained Remission ◽

Serious Infection

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Risk of serious infection in patients with rheumatoid arthritis-associated interstitial lung disease

Clinical Rheumatology ◽

10.1007/s10067-016-3357-z ◽

2016 ◽

Vol 35 (10) ◽

pp. 2585-2589 ◽

Cited By ~ 19

Author(s):

Jorge A. Zamora-Legoff ◽

Megan L. Krause ◽

Cynthia S. Crowson ◽

Jay H. Ryu ◽

Eric L. Matteson

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Serious Infection

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Clinical Utility of Neutrophil CD64 to Detect Extrapulmonary Tuberculosis in Three Patients with Rheumatoid Arthritis Undergoing Treatment with Biologics

Case Reports in Rheumatology ◽

10.1155/2018/2856546 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Shinichi Nogi ◽

Yoshiyuki Arinuma ◽

Akiko Komiya ◽

Atsushi Hashimoto ◽

Toshihiro Matsui ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Inflammatory Markers ◽

Clinical Utility ◽

Extrapulmonary Tuberculosis ◽

Clinical Problem ◽

Disease Flare ◽

Neutrophil Cd64 ◽

Serious Infection ◽

Problem Detection ◽

Insight Into

Biologics play a key role in the treatment of rheumatoid arthritis (RA), while RA-related serious infection remains an unsettled clinical problem. Detection of tuberculosis (TB) is challenging due to the difficulty in distinguishing symptoms such as fever and elevation of inflammatory markers from other infections or a disease flare of RA. The expression of the CD64 molecule on neutrophils (neutrophil CD64) was upregulated by various infections including TB. However, it was not affected by disease activity of RA or by any therapy against RA. The present article reports three cases of extrapulmonary TB which occurred in patients with RA undergoing treatment with biologics. The marked increase in the levels of neutrophil CD64 may provide important insight into the diagnosis of TB.

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