Children with juvenile idiopathic arthritis (JIA) have higher rates of hospitalized bacterial infection than children without JIA according to an observational study appearing in Arthritis & Rheumatism, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR). The findings show that the risk of infection among JIA patients was significantly increased with use of high-dose glucocorticoids (steroids). Methotrexate (MTX) and tumor necrosis factor alpha (TNF) inhibitors were not found to increase infection risk in this pediatric population.

Arthritis is an inflammation of the joints that causes pain, swelling, stiffness and can lead to disability. JIA refers to chronic arthritis diseases that attack young patients and the ACR estimates close to 300,000 children in the U.S are affected. While immunosuppressant therapies such as steroids, MTX, and TNF inhibitors are used to treat JIA, it is unclear how they impact infection risk.

To compare bacterial infection incidence in children with and without JIA, a research team led by Dr. Timothy Beukelman from the University of Alabama at Birmingham used U.S. Medicaid data from 2000 to 2005. The team identified 8,479 JIA patients with 13,003 person-years of follow-up and a group of 360,489 children with attention-deficit hyperactivity disorder (ADHD) for comparison. Pharmacy claims were used to determine exposure to MTX, TNF inhibitors, and oral steroid medications. Infections were identified using hospital discharge diagnoses.

Researchers determined that 42% of JIA patients used MTX and 17% used TNF inhibitors to manage their disease. JIA patients without current exposure to MTX or TNF inhibitors had an increased rate of bacterial infection compared to patients with ADHD, even after adjusting for steroid use. “Patients with JIA who were not currently treated with MTX or TNF inhibitors had a 2-fold increase in hospitalized bacterial infection rates compared to children without arthritis,” explains Dr. Beukelman, “This finding suggests the inflammatory or autoimmune process may predispose children to infection regardless of therapy.”

Among children with JIA, the rate of infection associated with MTX or TNF inhibitor use was similar. After adjusting for MTX and TNF inhibitor use among children with JIA, high-dose steroid use—10 mg or more of prednisone daily - more than doubled the rate of subsequent infection compared to patients not taking steroids. Dr. Beukelman concludes, “A steroid-sparing treatment strategy may reduce the risk of serious infection in children with JIA.”
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This research was supported by grants from the Agency for Healthcare Research and Quality (AHRQ), the Food and Drug Administration (FDA) U.S. Department of Health and Human Services (DHHS), and the National Institutes of Health (NIH).

This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of this article may contact .(JavaScript must be enabled to view this email address).

Full citation: “Rates of Hospitalized Bacterial Infection Associated with Juvenile Idiopathic Arthritis and Its Treatment.” Timothy Beukelman, Fenglong Xie, Lang Chen, John W Baddley, Elizabeth Delzell, Carlos G Grijalva, James D Lewis, Rita Ouellet-Hellstrom, Nivedita M Patkar, Kenneth G Saag, Kevin L Winthrop and Jeffrey R Curtis on behalf of the Safety Assessment of Biological ThERapeutics (SABER) Collaboration. Arthritis & Rheumatism; Published Online: May 1, 2012 (DOI: 10.1002/art.34458).

URL upon publication: http://doi.wiley.com/10.1002/art.34458.

Author Contacts: To arrange an interview with Dr. Beukelman, please contact Bob Shepard with the University of Alabama at Birmingham at .(JavaScript must be enabled to view this email address).

About the Journal:

Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), a division of the College, and covers all aspects of inflammatory disease. The American College of Rheumatology (http://www.rheumatology.org) is the professional organization who share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. The journal is published by Wiley-Blackwell on behalf of the ACR.

About Wiley-Blackwell:

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world’s leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit http://www.wileyblackwell.com or our new online platform, Wiley Online Library, one of the world’s most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.