Dr. Beukelman has received consulting fees, speaking fees, and/or honoraria from Novartis (less than $10,000) and a research grant from Pfizer.
Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment†
Article first published online: 27 JUL 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 64, Issue 8, pages 2773–2780, August 2012
How to Cite
Beukelman, T., Xie, F., Chen, L., Baddley, J. W., Delzell, E., Grijalva, C. G., Lewis, J. D., Ouellet-Hellstrom, R., Patkar, N. M., Saag, K. G., Winthrop, K. L., Curtis, J. R. and on behalf of the SABER Collaboration (2012), Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment. Arthritis & Rheumatism, 64: 2773–2780. doi: 10.1002/art.34458
Statements contained herein should not be construed as endorsement by the Agency for Healthcare Research and Quality, the FDA, or the US Department of Health and Human Services.
- Issue published online: 27 JUL 2012
- Article first published online: 27 JUL 2012
- Accepted manuscript online: 8 MAY 2012 02:27PM EST
- Manuscript Accepted: 23 FEB 2012
- Manuscript Received: 15 NOV 2011
- Agency for Healthcare Research and Quality (AHRQ)
- FDA, US Department of Health and Human Services. Grant Number: 1U18-HS-017919-0, administered through the AHRQ CERTs Program
- NIH. Grant Numbers: 5KL2-RR-025776 through the University of Alabama at Birmingham Center for Clinical and Translational Science, 5P60-AR-56116, AR-053351
- AHRQ. Grant Number: R01-HS-018517
To compare the incidence of hospitalized bacterial infections among children with and children without juvenile idiopathic arthritis (JIA) and to examine the effects of selected medications.
Using national Medicaid data from 2000 through 2005, we identified a cohort of children with JIA and a comparator cohort of children with attention deficit hyperactivity disorder (ADHD). Exposures to methotrexate (MTX), TNF inhibitors, and oral glucocorticoids (GCs) were determined using pharmacy claims. Patients hospitalized with bacterial infections were identified using coded discharge diagnoses. We calculated adjusted hazard ratios (HRadj) to compare infection incidence rates while adjusting for relevant covariates.
We identified 8,479 JIA patients with 13,003 person-years of followup; 36% took MTX and 16% took TNF inhibitors. Compared with ADHD patients, JIA patients who were not currently taking MTX or TNF inhibitors had an increased rate of infection (HRadj 2.0 [95% confidence interval (95% CI) 1.5, 2.5]). Among JIA patients not receiving TNF inhibitor therapy, MTX users had a similar rate of infection as those not currently taking MTX (HRadj 1.2 [95% CI 0.9, 1.7]). TNF inhibitor use (irrespective of MTX) resulted in a similar rate of infection as use of MTX without a TNF inhibitor (HRadj 1.2 [95% CI 0.8, 1.8]). Use of high-dose GCs (≥10 mg/day of prednisone or equivalent) increased the rate of infection as compared with no GC use, after adjustment for MTX and TNF inhibitor use (HRadj 3.1 [95% CI 2.0, 4.7]).
Children with JIA had an increased rate of infection compared to children with ADHD. Among children with JIA, the rate of infection was not increased with MTX or TNF inhibitor use, but was significantly increased with high-dose GC use.