Effect of different DMARD use on the frequency of urinary infection in patients with rheumatoid arthritis
Abstract
Aims: It is known that the susceptibility to infection in general is increased in Rheumatoid Arthritis (RA) patients, but there is not enough information about whether urinary tract infections in particular differ according to different disease-modifying antirheumatic drugs (DMARDs) groups. The aim of this study was to compare the frequency of urinary infection attacks and pathogens in urine cultures of patients with RA treated with different groups of DMARDs.
Methods: In this retrospective study, 76 patients using biologic DMARDs (bDMARDs) and 74 patients using conventional synthetic DMARDs (csDMARDs) among patients followed with a diagnosis of RA for at least 5 years who came for regular follow-ups at our department’s rheumatic diseases outpatient clinic were included. Patients with known immunodeficiency conditions, use of prednisolone (>7.5 mg), chronic renal failure, and renal pathologies were excluded from the study. The evaluation and follow-up records of the included patients between 01.01.2019 and 31.12.2022 were examined. Patients age, sex, medications, comorbidities, urine biochemistry, and urine culture results were recorded. Patients with pyuria detected by urine biochemistry were considered to have a urinary infection.
Results: The mean age of patients in the csDMARD group was 61.39±11.41 (37-87) and the mean age of patients in the bDMARD group was 58.68±11.42 (33-89) (p=0.149). The number of urinary infection attacks during the follow-up period was similar in both the groups (p =0.090). The positive culture rate was 23.21% in the bDMARD group and 7.5% in the csDMARD group (p = 0.072). Escherichia coli was detected in 81.8% and Pseudomonas aeruginosa was detected in 18.2% of the positive cultures in the bDMARD group. The pathogen in all positive cultures of the csDMARD group was Escherichia coli.
Conclusion: Although urinary infection and positive culture rates were higher in patients receiving bDMARDs, no statistically significant difference was observed between the groups.
References
- Jin J, Li J, Hou M, et al. A shifted urinary microbiota associated with disease activity and immune responses in rheumatoid arthritis. Microbiol Spectr. 2023;11(3):1-12.
- Puntis D, Malik S, Saravanan V, et al. Urinary tract infections in patients with rheumatoid arthritis. Clin Rheumatol. 2013; 32(3):355-360.
- Bergmans BJM, Gebeyehu BY, van Puijenbroek EP, et al. Infections in biological and targeted synthetic drug use in rheumatoid arthritis: where do we stand? a scoping review and meta-analysis. Rheumatol Ther. 2023;10(5):1147-1165.
- Smolen JS, Landewé RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3-18.
- Radu A-F, Bungau SG. Management of rheumatoid arthritis: an overview. Cells. 2021;10(11):2857.
- Furst DE. The risk of infections with biologic therapies for rheumatoid arthritis. Semin Arthritis Rheum. 2010;39(5):327-346.
- Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatol (Oxford). 2013;52(1):53-61.
- Cipriani P, Berardicurti O, Masedu F, et al. Biologic therapies and infections in the daily practice of three Italian rheumatologic units: a prospective, observational study. Clin Rheumatol. 2017; 36(2):251-260.
- Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269-284.
- Jeong S, Jeon K, Lee N, Park MJ, Song W. Changing genotypic distribution, antimicrobial susceptibilities, and risk factors of urinary tract infection caused by carbapenemase-producing pseudomonas aeruginosa. Ann Lab Med. 2024;44(1):38-46.
- Consani Fernández SA, Díaz Cuña CL, Fernández Rey L, Rostán Sellanes S, Maciel Oleggini G, Facal Castro JA. Infections in systemic autoimmune diseases. Reumatol Clín (Eng Ed.). 2021;17(10):582-587.
- Wang D, Yeo AL, Dendle C, Morton S, Morand E, Leech M. Severe infections remain common in a real-world rheumatoid arthritis cohort: a simple clinical model to predict infection risk. Eur J Rheumatol. 2021;8(3):133-138.
- Huang WN, Chuo CY, Lin CH, et al. Serious infection rates among patients with select autoimmune conditions: a claims-based retrospective cohort study from Taiwan and the USA. Rheumatol Ther. 2023;10(2):387-404.
- Sharma C, Keen H. Ten-year retrospective review of the incidence of serious infections in patients on biologic disease modifying agents for rheumatoid arthritis in three tertiary hospitals in Western Australia. Intern Med J. 2019;49(4):519-525.
- Dixon WG, Watson K, Lunt M, Hyrich KL, Silman AJ, Symmons DPM. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: Results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. 2006;54(8):2368-2376.
- Listing J, Strangfeld A, Kary S, et al. Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum. 2005;52(11):3403-3412.
- He B, Li Y, Luo WW, et al. The risk of adverse effects of TNF-α inhibitors in patients with rheumatoid arthritis: a network meta-analysis. Front Immunol. 2022;13:1-16.
- Dey M, Bechman K, Zhao S, et al. Infection profile of immune-modulatory drugs used in autoimmune diseases: analysis of summary of product characteristic data. RMD Open. 2022;8(2):1-8.
- Quach LT, Chang BH, Brophy MT, Thwin SS, Hannagan K, O’Dell JR. Rheumatoid arthritis triple therapy compared with etanercept: Difference in infectious and gastrointestinal adverse events. Rheumatol (Oxford). 2017;56(3):378-383.
- Balanescu AR, Citera G, Pascual-Ramos V, et al. Infections in patients with rheumatoid arthritis receiving tofacitinib versus tumour necrosis factor inhibitors: results from the open-label, randomised controlled ORAL Surveillance trial. Ann Rheum Dis. 2022;81(11):1491-1503.
- Yun H, Xie F, Delzell E, et al. Comparative risk of hospitalized infection associated with biologic agents in rheumatoid arthritis patients enrolled in medicare. Arthritis Rheumatol. 2016;68:56-66.
- Bechman K, Halai K, Yates M, et al. Nonserious infections in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics register for rheumatoid arthritis. Arthritis Rheumatol. 2021;73(10):1800-1809. doi:10.1002/art.41754
- Chiu YM, Chen DY. Infection risk in patients undergoing treatment for inflammatory arthritis: non-biologics versus biologics. Expert Rev Clin Immunol. 2020;16(2):207-228.
- Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol. 2010;7(12):653-660.
- Pérez-Sola MJ, Torre-Cisneros J, Pérez-Zafrilla B, Carmona L, Descalzo MA, Gómez-Reino JJ. Infecciones en pacientes tratados con antagonistas del factor de necrosis tumoral: incidencia, etiología y mortalidad en el registro BIOBADASER. Med Clin (Barc). 2011;137(12):533-540.
Abstract
References
- Jin J, Li J, Hou M, et al. A shifted urinary microbiota associated with disease activity and immune responses in rheumatoid arthritis. Microbiol Spectr. 2023;11(3):1-12.
- Puntis D, Malik S, Saravanan V, et al. Urinary tract infections in patients with rheumatoid arthritis. Clin Rheumatol. 2013; 32(3):355-360.
- Bergmans BJM, Gebeyehu BY, van Puijenbroek EP, et al. Infections in biological and targeted synthetic drug use in rheumatoid arthritis: where do we stand? a scoping review and meta-analysis. Rheumatol Ther. 2023;10(5):1147-1165.
- Smolen JS, Landewé RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3-18.
- Radu A-F, Bungau SG. Management of rheumatoid arthritis: an overview. Cells. 2021;10(11):2857.
- Furst DE. The risk of infections with biologic therapies for rheumatoid arthritis. Semin Arthritis Rheum. 2010;39(5):327-346.
- Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatol (Oxford). 2013;52(1):53-61.
- Cipriani P, Berardicurti O, Masedu F, et al. Biologic therapies and infections in the daily practice of three Italian rheumatologic units: a prospective, observational study. Clin Rheumatol. 2017; 36(2):251-260.
- Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269-284.
- Jeong S, Jeon K, Lee N, Park MJ, Song W. Changing genotypic distribution, antimicrobial susceptibilities, and risk factors of urinary tract infection caused by carbapenemase-producing pseudomonas aeruginosa. Ann Lab Med. 2024;44(1):38-46.
- Consani Fernández SA, Díaz Cuña CL, Fernández Rey L, Rostán Sellanes S, Maciel Oleggini G, Facal Castro JA. Infections in systemic autoimmune diseases. Reumatol Clín (Eng Ed.). 2021;17(10):582-587.
- Wang D, Yeo AL, Dendle C, Morton S, Morand E, Leech M. Severe infections remain common in a real-world rheumatoid arthritis cohort: a simple clinical model to predict infection risk. Eur J Rheumatol. 2021;8(3):133-138.
- Huang WN, Chuo CY, Lin CH, et al. Serious infection rates among patients with select autoimmune conditions: a claims-based retrospective cohort study from Taiwan and the USA. Rheumatol Ther. 2023;10(2):387-404.
- Sharma C, Keen H. Ten-year retrospective review of the incidence of serious infections in patients on biologic disease modifying agents for rheumatoid arthritis in three tertiary hospitals in Western Australia. Intern Med J. 2019;49(4):519-525.
- Dixon WG, Watson K, Lunt M, Hyrich KL, Silman AJ, Symmons DPM. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: Results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. 2006;54(8):2368-2376.
- Listing J, Strangfeld A, Kary S, et al. Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum. 2005;52(11):3403-3412.
- He B, Li Y, Luo WW, et al. The risk of adverse effects of TNF-α inhibitors in patients with rheumatoid arthritis: a network meta-analysis. Front Immunol. 2022;13:1-16.
- Dey M, Bechman K, Zhao S, et al. Infection profile of immune-modulatory drugs used in autoimmune diseases: analysis of summary of product characteristic data. RMD Open. 2022;8(2):1-8.
- Quach LT, Chang BH, Brophy MT, Thwin SS, Hannagan K, O’Dell JR. Rheumatoid arthritis triple therapy compared with etanercept: Difference in infectious and gastrointestinal adverse events. Rheumatol (Oxford). 2017;56(3):378-383.
- Balanescu AR, Citera G, Pascual-Ramos V, et al. Infections in patients with rheumatoid arthritis receiving tofacitinib versus tumour necrosis factor inhibitors: results from the open-label, randomised controlled ORAL Surveillance trial. Ann Rheum Dis. 2022;81(11):1491-1503.
- Yun H, Xie F, Delzell E, et al. Comparative risk of hospitalized infection associated with biologic agents in rheumatoid arthritis patients enrolled in medicare. Arthritis Rheumatol. 2016;68:56-66.
- Bechman K, Halai K, Yates M, et al. Nonserious infections in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics register for rheumatoid arthritis. Arthritis Rheumatol. 2021;73(10):1800-1809. doi:10.1002/art.41754
- Chiu YM, Chen DY. Infection risk in patients undergoing treatment for inflammatory arthritis: non-biologics versus biologics. Expert Rev Clin Immunol. 2020;16(2):207-228.
- Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol. 2010;7(12):653-660.
- Pérez-Sola MJ, Torre-Cisneros J, Pérez-Zafrilla B, Carmona L, Descalzo MA, Gómez-Reino JJ. Infecciones en pacientes tratados con antagonistas del factor de necrosis tumoral: incidencia, etiología y mortalidad en el registro BIOBADASER. Med Clin (Barc). 2011;137(12):533-540.
Details
| Primary Language | English |
|---|---|
| Subjects | Infectious Diseases, Rheumatology and Arthritis |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | January 15, 2024 |
| Submission Date | October 17, 2023 |
| Acceptance Date | December 8, 2023 |
| Published in Issue | Year 2024 Volume: 6 Issue: 1 |
TR DİZİN ULAKBİM and International Indexes (1b)
Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]
Note: Our journal is not WOS indexed and therefore is not classified as Q.
You can download Council of Higher Education (CoHG) [Yüksek Öğretim Kurumu (YÖK)] Criteria) decisions about predatory/questionable journals and the author's clarification text and journal charge policy from your browser. https://dergipark.org.tr/tr/journal/3449/file/4924/show
Journal Indexes and Platforms:
TR Dizin ULAKBİM, Google Scholar, Crossref, Worldcat (OCLC), DRJI, EuroPub, OpenAIRE, Turkiye Citation Index, Turk Medline, ROAD, ICI World of Journal's, Index Copernicus, ASOS Index, General Impact Factor, Scilit.The indexes of the journal's are;
|
|
|
|
The platforms of the journal's are;
|
|
|
|
The indexes/platforms of the journal are;
TR Dizin Ulakbim, Crossref (DOI), Google Scholar, EuroPub, Directory of Research Journal İndexing (DRJI), Worldcat (OCLC), OpenAIRE, ASOS Index, ROAD, Turkiye Citation Index, ICI World of Journal's, Index Copernicus, Turk Medline, General Impact Factor, Scilit
EBSCO, DOAJ, OAJI is under evaluation.
Journal articles are evaluated as "Double-Blind Peer Review"