In the Journals

Glucocorticoid use tied to increased risk for infection in patients with RA after arthroplasty

Patients with rheumatoid arthritis who used glucocorticoids and underwent knee or hip arthroplasty were at an increased risk for adverse events, according to a recent study published in the Annals of Internal Medicine.

“Joint arthroplasty can be complicated not only by immediate postoperative infections but also by prosthetic joint infection (PJI), a serious complication that can occur later after surgery,” Michael D. George, MD, MSCE, of the University of Pennsylvania Perelman School of Medicine, and colleagues wrote. “Understanding risk for postoperative infection with different immunosuppressive therapies is important to optimizing perioperative management.”

To address this concern, researchers conducted a retrospective cohort study using data from Medicare claims and the database MarketScan between Jan. 1, 2006, and Sept. 30, 2015. Patients included in the study had RA, were aged 18 years and older and underwent inpatient elective hip or knee arthroplasty between Jan. 1, 2007 and Aug. 31, 2015. Those included in the study were required to have data available to establish a 1-year baseline period.

The primary outcomes of the study were hospitalized infections within 30 days and PJI within 1 year following an arthroplasty procedure. The risk for the primary outcomes with the use of biologics and different dosages of glucocorticoids were comparatively evaluated with propensity-adjusted analyses that used inverse probability weights.

A total of 9,911 patients and 10,923 arthroplasty procedures were included in the study. Researchers found that those who received different biologics before surgery were at similar risks for postoperative complications.

Glucocorticoids had a dose-dependent increase in postoperative risk for all outcomes. Propensity-weighted models found that 10 mg per day of glucocorticoids created a predicted risk for hospitalized infection within 30 days after surgery of 13.25% (CI, 9.72-17.81) compared with a 6.78% risk without glucocorticoid use.

The predicted incidence of PJI within 1 year following surgery was 3.83% (CI, 2.13-6.87) for those who took 10 mg of glucocorticoid per day and 2.09% for those who did not take glucocorticoids.

“The study does not resolve the question of whether withholding biologic therapies in the perioperative period actually reduces patients' overall risk for infection complications,” Bheeshma Ravi, MD, PhD, and Gillian Hawker, MD, MSc, of the University of Toronto, wrote in an editorial accompanying the study. “Instead, it provides compelling evidence, once again, of the substantial risk for serious postoperative infections associated with glucocorticoid use. There is a critical need for research to elucidate the risks and benets of withholding biologics to optimize patient outcomes.” – by Erin Michael

Disclosures: George reports grants from the Rheumatology Research Foundation, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and Bristol-Myers Squibb and personal fees from AbbVie outside the submitted work. Please see study for all other authors’ relevant financial disclosures.

Patients with rheumatoid arthritis who used glucocorticoids and underwent knee or hip arthroplasty were at an increased risk for adverse events, according to a recent study published in the Annals of Internal Medicine.

“Joint arthroplasty can be complicated not only by immediate postoperative infections but also by prosthetic joint infection (PJI), a serious complication that can occur later after surgery,” Michael D. George, MD, MSCE, of the University of Pennsylvania Perelman School of Medicine, and colleagues wrote. “Understanding risk for postoperative infection with different immunosuppressive therapies is important to optimizing perioperative management.”

To address this concern, researchers conducted a retrospective cohort study using data from Medicare claims and the database MarketScan between Jan. 1, 2006, and Sept. 30, 2015. Patients included in the study had RA, were aged 18 years and older and underwent inpatient elective hip or knee arthroplasty between Jan. 1, 2007 and Aug. 31, 2015. Those included in the study were required to have data available to establish a 1-year baseline period.

The primary outcomes of the study were hospitalized infections within 30 days and PJI within 1 year following an arthroplasty procedure. The risk for the primary outcomes with the use of biologics and different dosages of glucocorticoids were comparatively evaluated with propensity-adjusted analyses that used inverse probability weights.

A total of 9,911 patients and 10,923 arthroplasty procedures were included in the study. Researchers found that those who received different biologics before surgery were at similar risks for postoperative complications.

Glucocorticoids had a dose-dependent increase in postoperative risk for all outcomes. Propensity-weighted models found that 10 mg per day of glucocorticoids created a predicted risk for hospitalized infection within 30 days after surgery of 13.25% (CI, 9.72-17.81) compared with a 6.78% risk without glucocorticoid use.

The predicted incidence of PJI within 1 year following surgery was 3.83% (CI, 2.13-6.87) for those who took 10 mg of glucocorticoid per day and 2.09% for those who did not take glucocorticoids.

“The study does not resolve the question of whether withholding biologic therapies in the perioperative period actually reduces patients' overall risk for infection complications,” Bheeshma Ravi, MD, PhD, and Gillian Hawker, MD, MSc, of the University of Toronto, wrote in an editorial accompanying the study. “Instead, it provides compelling evidence, once again, of the substantial risk for serious postoperative infections associated with glucocorticoid use. There is a critical need for research to elucidate the risks and benets of withholding biologics to optimize patient outcomes.” – by Erin Michael

Disclosures: George reports grants from the Rheumatology Research Foundation, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and Bristol-Myers Squibb and personal fees from AbbVie outside the submitted work. Please see study for all other authors’ relevant financial disclosures.