Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Arthritis Research & Therapy
Published in: Arthritis Research & Therapy 4/2011

Open Access 01-08-2011 | Research article

The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: systematic review and meta-analyses

Authors: William G Dixon, Samy Suissa, Marie Hudson

Published in: Arthritis Research & Therapy | Issue 4/2011

Login to get access

Abstract

Introduction

Infection is a major cause of morbidity and mortality in patients with rheumatoid arthritis (RA). The objective of this study was to perform a systematic review and meta-analysis of the effect of glucocorticoid (GC) therapy on the risk of infection in patients with RA.

Methods

A systematic review was conducted by using MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials database to January 2010 to identify studies among populations of patients with RA that reported a comparison of infection incidence between patients treated with GC therapy and patients not exposed to GC therapy.

Results

In total, 21 randomised controlled trials (RCTs) and 42 observational studies were included. In the RCTs, GC therapy was not associated with a risk of infection (relative risk (RR), 0.97 (95% CI, 0.69, 1.36)). Small numbers of events in the RCTs meant that a clinically important increased or decreased risk could not be ruled out. The observational studies generated a RR of 1.67 (1.49, 1.87), although significant heterogeneity was present. The increased risk (and heterogeneity) persisted when analyses were stratified by varying definitions of exposure, outcome, and adjustment for confounders. A positive dose-response effect was seen.

Conclusions

Whereas observational studies suggested an increased risk of infection with GC therapy, RCTs suggested no increased risk. Inconsistent reporting of safety outcomes in the RCTs, as well as marked heterogeneity, probable residual confounding, and publication bias in the observational studies, limits the opportunity for a definitive conclusion. Clinicians should remain vigilant for infection in patients with RA treated with GC therapy.
Appendix
Available only for authorised users
Literature
1.
Doran MF, Crowson CS, Pond GR, O'Fallon WM, Gabriel SE: Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum. 2002, 46: 2287-2293. 10.1002/art.10524.CrossRefPubMed
2.
Thomas E, Symmons DP, Brewster DH, Black RJ, Macfarlane GJ: National study of cause-specific mortality in rheumatoid arthritis, juvenile chronic arthritis, and other rheumatic conditions: a 20 year followup study. J Rheumatol. 2003, 30: 958-965.PubMed
3.
Caplan L, Wolfe F, Russell AS, Michaud K: Corticosteroid use in rheumatoid arthritis: prevalence, predictors, correlates, and outcomes. J Rheumatol. 2007, 34: 696-705.PubMed
4.
Hoes JN, Jacobs JW, Boers M, Boumpas D, Buttgereit F, Caeyers N, Choy EH, Cutolo M, Da Silva JA, Esselens G, Guillevin L, Hafstrom I, Kirwan JR, Rovensky J, Russell A, Saag KG, Svensson B, Westhovens R, Zeidler H, Bijlsma JW: EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis. 2007, 66: 1560-1567. 10.1136/ard.2007.072157.PubMedCentralCrossRefPubMed
5.
Cutolo M, Seriolo B, Pizzorni C, Secchi ME, Soldano S, Paolino S, Montagna P, Sulli A: Use of glucocorticoids and risk of infections. Autoimmun Rev. 2008, 8: 153-155. 10.1016/j.autrev.2008.07.010.CrossRefPubMed
6.
Hench PS, Kendall EC, Slocumb CH, Polley HF: Effects of cortisone acetate and pituitary ACTH on rheumatoid arthritis, rheumatic fever and certain other conditions. Arch Intern Med (Chic). 1950, 85: 545-666.CrossRef
7.
Kirwan JR, Bijlsma JW, Boers M, Shea BJ: Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database Syst Rev. 2007, CD006356-
8.
Hoes JN, Jacobs JW, Verstappen SM, Bijlsma JW, Van der Heijden GJ: Adverse events of low- to medium-dose oral glucocorticoids in inflammatory diseases: a meta-analysis. Ann Rheum Dis. 2009, 68: 1833-1838. 10.1136/ard.2008.100008.CrossRefPubMed
9.
Da Silva JAP, Jacobs JWG, Kirwan JR, Boers M, Saag KG, Ines LBS, de Koning EJP, Buttgereit F, Cutolo M, Capell H, Rau R, Bijlsma JWJ: Safety of low dose glucocorticoid treatment in rheumatoid arthritis: published evidence and prospective trial data. Ann Rheum Dis. 2006, 65: 285-293. 10.1136/ard.2005.038638.PubMedCentralCrossRefPubMed
10.
11.
Bradburn MJ, Deeks JJ, Berlin JA, Russell Localio A: Much ado about nothing: a comparison of the performance of meta-analytical methods with rare events. Stat Med. 2007, 26: 53-77. 10.1002/sim.2528.CrossRefPubMed
12.
DerSimonian R, Laird N: Meta-analysis in clinical trials. Controlled Clinical Trials. 1986, 7: 177-188. 10.1016/0197-2456(86)90046-2.CrossRefPubMed
13.
Sterne JA, Egger M, Smith GD: Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ. 2001, 323: 101-105. 10.1136/bmj.323.7304.101.PubMedCentralCrossRefPubMed
14.
15.
Boers M, Verhoeven AC, Markusse HM, van de Laar MA, Westhovens R, van Denderen JC, van Zeben D, Dijkmans BA, Peeters AJ, Jacobs P, van den Brink HR, Schouten HJ, van der Heijde DM, Boonen A, van der Linden S: Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet. 1997, 350: 309-318. 10.1016/S0140-6736(97)01300-7.CrossRefPubMed
16.
Chamberlain MA, Keenan J: The effect of low doses of prednisolone compared with placebo on function and on the hypothalamic pituitary adrenal axis in patients with rheumatoid arthritis. Rheumatol Rehabil. 1976, 15: 17-23. 10.1093/rheumatology/15.1.17.CrossRefPubMed
17.
Choy EH, Kingsley GH, Khoshaba B, Pipitone N, Scott DL, Intramuscular Methylprednisolone Study G: A two year randomised controlled trial of intramuscular depot steroids in patients with established rheumatoid arthritis who have shown an incomplete response to disease modifying antirheumatic drugs. Ann Rheum Dis. 2005, 64: 1288-1293. 10.1136/ard.2004.030908.PubMedCentralCrossRefPubMed
18.
Choy EH, Smith CM, Farewell V, Walker D, Hassell A, Chau L, Scott DL, Group CT: Factorial randomised controlled trial of glucocorticoids and combination disease modifying drugs in early rheumatoid arthritis. Ann Rheum Dis. 2008, 67: 656-663.CrossRefPubMed
19.
Durez P, Malghem J, Nzeusseu Toukap A, Depresseux G, Lauwerys BR, Westhovens R, Luyten FP, Corluy L, Houssiau FA, Verschueren P: Treatment of early rheumatoid arthritis: a randomized magnetic resonance imaging study comparing the effects of methotrexate alone, methotrexate in combination with infliximab, and methotrexate in combination with intravenous pulse methylprednisolone. Arthritis Rheum. 2007, 56: 3919-3927. 10.1002/art.23055.CrossRefPubMed
20.
Durez P, Nzeusseu Toukap A, Lauwerys BR, Manicourt DH, Verschueren P, Westhovens R, Devogelaer JP, Houssiau FA: A randomised comparative study of the short term clinical and biological effects of intravenous pulse methylprednisolone and infliximab in patients with active rheumatoid arthritis despite methotrexate treatment. Ann Rheum Dis. 2004, 63: 1069-1074. 10.1136/ard.2003.012914.PubMedCentralCrossRefPubMed
21.
Gerlag DM, Haringman JJ, Smeets TJ, Zwinderman AH, Kraan MC, Laud PJ, Morgan S, Nash AF, Tak PP: Effects of oral prednisolone on biomarkers in synovial tissue and clinical improvement in rheumatoid arthritis. Arthritis Rheum. 2004, 50: 3783-3791. 10.1002/art.20664.CrossRefPubMed
22.
Heytman M, Ahern MJ, Smith MD, Roberts-Thomson PJ: The longterm effect of pulsed corticosteroids on the efficacy and toxicity of chrysotherapy in rheumatoid arthritis. J Rheumatol. 1994, 21: 435-441.PubMed
23.
Jasani MK, Downie WW, Samuels BM, Buchanan WW: Ibuprofen in rheumatoid arthritis. Clinical study of analgesic and anti-inflammatory activity. Annal Rheum Diss. 1968, 27: 457-462. 10.1136/ard.27.5.457.CrossRef
24.
Kirwan JR, Hällgren R, Mielants H, Wollheim F, Bjorck E, Persson T, Book C, Bowman S, Byron M, Cox N, Field M, Kanerud L, Leirisalo-Repo M, Malaise M, Mohammad A, Palmer R, Petersson IF, Ringertz B, Sheldon P, Simonsson M, Snowden N, Van den Bosch F: A randomised placebo controlled 12 week trial of budesonide and prednisolone in rheumatoid arthritis. Ann Rheum Dis. 2004, 63: 688-695. 10.1136/ard.2003.008573.PubMedCentralCrossRefPubMed
25.
Liebling MR, Leib E, McLaughlin K, Blocka K, Furst DE, Nyman K, Paulus HE: Pulse methylprednisolone in rheumatoid arthritis: a double-blind cross-over trial. Ann Intern Med. 1981, 94: 21-26.CrossRefPubMed
26.
Murthy MH, Rhymer AR, Wright V: Indomethacin or prednisolone at night in rheumatoid arthritis?. Rheumatol Rehabil. 1978, 17: 8-13. 10.1093/rheumatology/17.1.8.CrossRefPubMed
27.
Sheldon P: Ileum-targeted steroid therapy in rheumatoid arthritis: double-blind, placebo-controlled trial of controlled-release budesonide. Rheumatol Intern. 2003, 23: 154-158. 10.1007/s00296-002-0278-8.CrossRef
28.
van Everdingen AA, Jacobs JW, Siewertsz Van Reesema DR, Bijlsma JW: Low-dose prednisone therapy for patients with early active rheumatoid arthritis: clinical efficacy, disease-modifying properties, and side effects: a randomized, double-blind, placebo-controlled clinical trial. Ann Intern Med. 2002, 136: 1-12.CrossRefPubMed
29.
Wassenberg S, Rau R, Steinfeld P, Zeidler H: Very low-dose prednisolone in early rheumatoid arthritis retards radiographic progression over two years: A multicenter, double-blind, placebo-controlled trial. Arthritis and Rheumatism. 2005, 52: 3371-3380. 10.1002/art.21421.CrossRefPubMed
30.
Williams IA, Baylis EM, Shipley ME: A double-blind placebo-controlled trial of methylprednisolone pulse therapy in active rheumatoid disease. Lancet. 1982, 2: 237-240.CrossRefPubMed
31.
Wong CS, Champion G, Smith MD, Soden M, Wetherall M, Geddes RA, Hill WR, Ahern MJ, Roberts-Thomson PJ: Does steroid pulsing influence the efficacy and toxicity of chrysotherapy? A double blind, placebo controlled study. Ann Rheum Dis. 1990, 49: 370-372. 10.1136/ard.49.6.370.PubMedCentralCrossRefPubMed
32.
Capell HA, Madhok R, Hunter JA, Porter D, Morrison E, Larkin J, Thomson EA, Hampson R, Poon FW: Lack of radiological and clinical benefit over two years of low dose prednisolone for rheumatoid arthritis: results of a randomised controlled trial. Ann Rheum Dis. 2004, 63: 797-803. 10.1136/ard.2003.014050.PubMedCentralCrossRefPubMed
33.
Svensson B, Boonen A, Albertsson K, van der Heijde D, Keller C, Hafström I: Low-dose prednisolone in addition to the initial disease-modifying antirheumatic drug in patients with early active rheumatoid arthritis reduces joint destruction and increases the remission rate: a two-year randomized trial. Arthritis Rheum. 2005, 52: 3360-3370. 10.1002/art.21298.CrossRefPubMed
34.
van der Veen MJ, Bijlsma JW: The effect of methylprednisolone pulse therapy on methotrexate treatment of rheumatoid arthritis. Clinic Rheumatol. 1993, 12: 500-505. 10.1007/BF02231779.CrossRef
35.
van Schaardenburg D, Valkema R, Dijkmans BA, Papapoulos S, Zwinderman AH, Han KH, Pauwels EK, Breedveld FC: Prednisone treatment of elderly-onset rheumatoid arthritis. Disease activity and bone mass in comparison with chloroquine treatment. Arthritis Rheum. 1995, 38: 334-342. 10.1002/art.1780380307.CrossRefPubMed
36.
Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Feltelius N, Coster L, Geborek P, Jacobsson LT, Lindblad S, Lysholm J, Rantapaa-Dahlqvist S, Saxne T, van Vollenhoven RF, Klareskog L: Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists. [Erratum appears in Ann Rheum Dis 2007 Nov; 66:1548]. Ann Rheum Dis. 2007, 66: 1339-1344. 10.1136/ard.2006.062760.PubMedCentralCrossRefPubMed
37.
Franklin J, Lunt M, Bunn D, Symmons D, Silman A: Risk and predictors of infection leading to hospitalisation in a large primary-care-derived cohort of patients with inflammatory polyarthritis. Ann Rheum Dis. 2007, 66: 308-312. 10.1136/ard.2006.057265.PubMedCentralCrossRefPubMed
38.
Bergstrom L, Yocum DE, Ampel NM, Villanueva I, Lisse J, Gluck O, Tesser J, Posever J, Miller M, Araujo J, Kageyama DM, Berry M, Karl L, Yung CM: Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor alpha antagonists. Arthritis Rheum. 2004, 50: 1959-1966. 10.1002/art.20454.CrossRefPubMed
39.
Bernatsky S, Hudson M, Suissa S: Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology. 2007, 46: 1157-1160. 10.1093/rheumatology/kem076.CrossRefPubMed
40.
Bongartz T, Halligan CS, Osmon DR, Reinalda MS, Bamlet WR, Crowson CS, Hanssen AD, Matteson EL: Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Care Res. 2008, 59: 1713-1720. 10.1002/art.24060.CrossRef
41.
Brassard P, Kezouh A, Suissa S: Antirheumatic drugs and the risk of tuberculosis. Clin Infect Dis. 2006, 43: 717-722. 10.1086/506935.CrossRefPubMed
42.
Brassard P, Lowe AM, Bernatsky S, Kezouh A, Suissa S: Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada. Arthritis Care Res. 2009, 61: 300-304. 10.1002/art.24476.CrossRef
43.
Breedveld FC, Fibbe WE, Hermans J, van der Meer JW, Cats A: Factors influencing the incidence of infections in Felty's syndrome. Arch Intern Med. 1987, 147: 915-920. 10.1001/archinte.147.5.915.CrossRefPubMed
44.
Carpenter MT, West SG, Vogelgesang SA, Casey Jones DE: Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy. Orthopedics. 1996, 19: 207-210.PubMed
45.
Coyne P, Hamilton J, Heycock C, Saravanan V, Coulson E, Kelly CA: Acute lower respiratory tract infections in patients with rheumatoid arthritis. J Rheumatol. 2007, 34: 1832-1836.PubMed
46.
Curtis JR, Patkar N, Xie A, Martin C, Allison JJ, Saag M, Shatin D, Saag KG: Risk of serious bacterial infections among rheumatoid arthritis patients exposed to tumor necrosis factor alpha antagonists. Arthritis Rheum. 2007, 56: 1125-1133. 10.1002/art.22504.CrossRefPubMed
47.
Doran MF, Crowson CS, Pond GR, O'Fallon WM, Gabriel SE: Predictors of infection in rheumatoid arthritis. Arthritis Rheum. 2002, 46: 2294-2300. 10.1002/art.10529.CrossRefPubMed
48.
Edwards CJ, Cooper C, Fisher D, Field M, Van Staa TP, Arden NK: The importance of the disease process and disease-modifying antirheumatic drug treatment in the development of septic arthritis in patients with rheumatoid arthritis. Arthritis Care Res. 2007, 57: 1151-1157. 10.1002/art.23003.CrossRef
49.
Favalli EG, Desiati F, Atzeni F, Sarzi-Puttini P, Caporali R, Pallavicini FB, Gorla R, Filippini M, Marchesoni A: Serious infections during anti-TNFalpha treatment in rheumatoid arthritis patients. Autoimmun Rev. 2009, 8: 266-273. 10.1016/j.autrev.2008.11.002.CrossRefPubMed
50.
Fleischmann RM, Tesser J, Schiff MH, Schechtman J, Burmester GR, Bennett R, Modafferi D, Zhou L, Bell D, Appleton B: Safety of extended treatment with anakinra in patients with rheumatoid arthritis. Ann Rheum Dis. 2006, 65: 1006-1012. 10.1136/ard.2005.048371.PubMedCentralCrossRefPubMed
51.
Giles JT, Bartlett SJ, Gelber AC, Nanda S, Fontaine K, Ruffing V, Bathon JM: Tumor necrosis factor inhibitor therapy and risk of serious postoperative orthopedic infection in rheumatoid arthritis. Arthritis Care Res. 2006, 55: 333-337. 10.1002/art.21841.CrossRef
52.
Grijalva CG, Kaltenbach L, Arbogast PG, Mitchel EF, Griffin MR: Initiation of rheumatoid arthritis treatments and the risk of serious infections. Rheumatology. 2010, 49: 82-90. 10.1093/rheumatology/kep325.PubMedCentralCrossRefPubMed
53.
Hamalainen M, Raunio P, Von Essen R: Postoperative wound infection in rheumatoid arthritis surgery. Clin Rheumatol. 1984, 3: 329-335. 10.1007/BF02032339.CrossRefPubMed
54.
Harigai M, Koike R, Miyasaka N: Pneumocystis pneumonia associated with infliximab in Japan. N Engl J Med. 2007, 357: 1874-1876. 10.1056/NEJMc070728.CrossRefPubMed
55.
Hernandez-Cruz B, Cardiel MH, Villa AR, Alcocer-Varela J: Development, recurrence, and severity of infections in Mexican patients with rheumatoid arthritis: a nested case-control study. J Rheumatol. 1998, 25: 1900-1907.PubMed
56.
Huscher D, Thiele K, Gromnica-Ihle E, Hein G, Demary W, Dreher R, Zink A, Buttgereit F: Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis. 2009, 68: 1119-1124. 10.1136/ard.2008.092163.CrossRefPubMed
57.
Jain A, Witbreuk M, Ball C, Nanchahal J: Influence of steroids and methotrexate on wound complications after elective rheumatoid hand and wrist surgery. J Hand Surg. 2002, 27: 449-455. 10.1053/jhsu.2002.32958.CrossRef
58.
Jenks KA, Stamp LK, O'Donnell JL, Savage RL, Chapman PT: Leflunomide-associated infections in rheumatoid arthritis. J Rheumatol. 2007, 34: 2201-2203.PubMed
59.
Lacaille D, Guh DP, Abrahamowicz M, Anis AH, Esdaile JM: Use of nonbiologic disease-modifying antirheumatic drugs and risk of infection in patients with rheumatoid arthritis. Arthritis Care Res. 2008, 59: 1074-1081. 10.1002/art.23913.CrossRef
60.
Luessenhop CP, Higgins LD, Brause BD, Ranawat CS: Multiple prosthetic infections after total joint arthroplasty: risk factor analysis. J Arthroplasty. 1996, 11: 862-868. 10.1016/S0883-5403(96)80189-6.CrossRefPubMed
61.
Malysheva OA, Wahle M, Wagner U, Pierer M, Arnold S, Hantzschel H, Baerwald CG: Low-dose prednisolone in rheumatoid arthritis: adverse effects of various disease modifying antirheumatic drugs. J Rheumatol. 2008, 35: 979-985.PubMed
62.
McDonald JR, Zeringue AL, Caplan L, Ranganathan P, Xian H, Burroughs TE, Fraser VJ, Cunningham F, Eisen SA: Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis. Clin Infect Dis. 2009, 48: 1364-1371. 10.1086/598331.PubMedCentralCrossRefPubMed
63.
Mertz LE, Blair JE: Coccidioidomycosis in rheumatology patients: incidence and potential risk factors. Ann N Y Acad Sci. 2007, 1111: 343-357. 10.1196/annals.1406.027.CrossRefPubMed
64.
Murata K, Yasuda T, Ito H, Yoshida M, Shimizu M, Nakamura T: Lack of increase in postoperative complications with low-dose methotrexate therapy in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Mod Rheumatol. 2006, 16: 14-19. 10.1007/s10165-005-0444-4.CrossRefPubMed
65.
Saag KG, Koehnke R, Caldwell JR, Brasington R, Burmeister LF, Zimmerman B, Kohler JA, Furst DE: Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med. 1994, 96: 115-123. 10.1016/0002-9343(94)90131-7.CrossRefPubMed
66.
Salliot C, Gossec L, Ruyssen-Witrand A, Luc M, Duclos M, Guignard S, Dougados M: Infections during tumour necrosis factor-alpha blocker therapy for rheumatic diseases in daily practice: a systematic retrospective study of 709 patients. Rheumatology. 2007, 46: 327-334.CrossRefPubMed
67.
Schnabel A, Herlyn K, Burchardi C, Reinhold-Keller E, Gross WL: Long term tolerability of methotrexate at doses exceeding 15 mg per week in rheumatoid arthritis. Rheumatol Int. 1995, 15: 195-200.CrossRef
68.
Schneeweiss S, Setoguchi S, Weinblatt ME, Katz JN, Avorn J, Sax PE, Levin R, Solomon DH: Anti-tumor necrosis factor alpha therapy and the risk of serious bacterial infections in elderly patients with rheumatoid arthritis. Arthritis Rheum. 2007, 56: 1754-1764. 10.1002/art.22600.CrossRefPubMed
69.
Sihvonen S, Korpela M, Mustonen J, Huhtala H, Karstila K, Pasternack A: Mortality in patients with rheumatoid arthritis treated with low-dose oral glucocorticoids: a population-based cohort study. J Rheumatol. 2006, 33: 1740-1746.PubMed
70.
Smitten AL, Choi HK, Hochberg MC, Suissa S, Simon TA, Testa MA, Chan KA: The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom. Arthritis Care Res. 2007, 57: 1431-1438. 10.1002/art.23112.CrossRef
71.
Smitten AL, Choi HK, Hochberg MC, Suissa S, Simon TA, Testa MA, Chan KA: The risk of hospitalized infection in patients with rheumatoid arthritis. J Rheumatol. 2008, 35: 387-393.PubMed
72.
Strangfeld A, Listing J, Herzer P, Liebhaber A, Rockwitz K, Richter C, Zink A: Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents. JAMA. 2009, 301: 737-744. 10.1001/jama.2009.146.CrossRefPubMed
73.
Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S: Examination of the risk of continuous leflunomide treatment on the incidence of infectious complications after joint arthroplasty in patients with rheumatoid arthritis. J Clin Rheumatol. 2003, 9: 115-118. 10.1097/01.RHU.0000062514.54375.bd.CrossRefPubMed
74.
Wilson MG, Kelley K, Thornhill TS: Infection as a complication of total knee-replacement arthroplasty: risk factors and treatment in sixty-seven cases. J Bone Joint Surg. 1990, 72: 878-883.PubMed
75.
Wolfe F, Caplan L, Michaud K: Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy. Arthritis Rheum. 2006, 54: 628-634. 10.1002/art.21568.CrossRefPubMed
76.
Wolfe F, Michaud K, Anderson J, Urbansky K: Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy. Arthritis Rheum. 2004, 50: 372-379. 10.1002/art.20009.CrossRefPubMed
77.
Wolfe F, Michaud K, Chakravarty EF: Rates and predictors of herpes zoster in patients with rheumatoid arthritis and non-inflammatory musculoskeletal disorders. Rheumatology. 2006, 45: 1370-1375. 10.1093/rheumatology/kel328.CrossRefPubMed
78.
van Gestel AM, Laan RF, Haagsma CJ, van de Putte LB, van Riel PL: Oral steroids as bridge therapy in rheumatoid arthritis patients starting with parenteral gold: a randomized double-blind placebo-controlled trial. Br J Rheumatol. 1995, 34: 347-351. 10.1093/rheumatology/34.4.347.CrossRefPubMed
79.
Kirwan JR: The effect of glucocorticoids on joint destruction in rheumatoid arthritis: the Arthritis and Rheumatism Council Low-Dose Glucocorticoid Study Group. N Engl J Med. 1995, 333: 142-146. 10.1056/NEJM199507203330302.CrossRefPubMed
80.
Harris ED, Emkey RD, Nichols JE, Newberg A: Low dose prednisone therapy in rheumatoid arthritis: a double blind study. J Rheumatol. 1983, 10: 713-721.PubMed
81.
Pincus T, Swearingen CJ, Luta G, Sokka T: Efficacy of prednisone 1-4 mg/day in patients with rheumatoid arthritis: a randomised, double-blind, placebo controlled withdrawal clinical trial. Ann Rheum Dis. 2009, 68: 1715-1720. 10.1136/ard.2008.095539.PubMedCentralCrossRefPubMed
82.
Chou R, Aronson N, Atkins D, Ismaila AS, Santaguida P, Smith DH, Whitlock E, Wilt TJ, Moher D: AHRQ series paper 4: assessing harms when comparing medical interventions: AHRQ and the effective health-care program. J Clin Epidemiol. 2010, 63: 502-512. 10.1016/j.jclinepi.2008.06.007.CrossRefPubMed
83.
Ashworth M, Latinovic R, Charlton J, Cox K, Rowlands G, Gulliford M: Why has antibiotic prescribing for respiratory illness declined in primary care? A longitudinal study using the General Practice Research Database. J Public Health (Oxf). 2004, 26: 268-274. 10.1093/pubmed/fdh160.CrossRef
84.
Shapiro S: Meta-analysis/Shmeta-analysis. Am J Epidemiol. 1994, 140: 771-778.PubMed
85.
86.
Dixon WG, Symmons DP, Lunt M, Watson KD, Hyrich KL, Silman AJ: Serious infection following anti-tumor necrosis factor alpha therapy in patients with rheumatoid arthritis: lessons from interpreting data from observational studies. Arthritis Rheum. 2007, 56: 2896-2904. 10.1002/art.22808.PubMedCentralCrossRefPubMed
87.
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: 2368-2376. 10.1002/art.21978.CrossRefPubMed
88.
den Broeder AA, Creemers MC, Fransen J, de Jong E, de Rooij DJ, Wymenga A, de Waal-Malefijt M: Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study. J Rheumatol. 2007, 34: 689-695.PubMed
89.
Bombardieri S, Ruiz AA, Fardellone P, Geusens P, McKenna F, Unnebrink K, Oezer U, Kary S, Kupper H, Burmester GR: Effectiveness of adalimumab for rheumatoid arthritis in patients with a history of TNF-antagonist therapy in clinical practice. Rheumatology. 2007, 46: 1191-1199. 10.1093/rheumatology/kem091.CrossRefPubMed
90.
Burmester GR, Mariette X, Montecucco C, Monteagudo-Saez I, Malaise M, Tzioufas AG, Bijlsma JWJ, Unnebrink K, Kary S, Kupper H: Adalimumab alone and in combination with disease-modifying antirheumatic drugs for the treatment of rheumatoid arthritis in clinical practice: The Research in Active Rheumatoid Arthritis (ReAct) trial. Ann Rheum Dis. 2007, 66: 732-739. 10.1136/ard.2006.066761.PubMedCentralCrossRefPubMed
91.
Hetland ML, Unkerskov J, Ravn T, Friis M, Tarp U, Andersen LS, Petri A, Khan H, Stenver DI, Hansen A, Ostergaard M: Routine database registration of biological therapy increases the reporting of adverse events twentyfold in clinical practice: first results from the Danish Database (DANBIO). Scand J Rheumat. 2005, 34: 40-44. 10.1080/03009740510017968.CrossRef
92.
Listing J, Strangfeld A, Kary S, Rau R, Von Hinueber U, Stoyanova-Scholz M, Gromnica-Ihle E, Antoni C, Herzer P, Kekow J, Schneider M, Zink A: Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum. 2005, 52: 3403-3412. 10.1002/art.21386.CrossRefPubMed
93.
Williams IA, Mitchell AD, Rothman W, Tallett P, Williams K, Pitt P: Survey of the long term incidence of osteonecrosis of the hip and adverse medical events in rheumatoid arthritis after high dose intravenous methylprednisolone. Ann Rheum Dis. 1988, 47: 930-933. 10.1136/ard.47.11.930.PubMedCentralCrossRefPubMed
94.
Bicer A, Tursen U, Cimen OB, Kaya TI, Ozisik S, Ikizoglu G, Erdogan C: Prevalence of dermatophytosis in patients with rheumatoid arthritis. Rheumatol Int. 2003, 23: 37-40.CrossRefPubMed
95.
Stang A: Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010, 25: 603-605. 10.1007/s10654-010-9491-z.CrossRefPubMed
96.
Santaguida P, Raina P, Ismaila A: McMaster Quality Assessment Scale of Harms (McHarm) for primary studies. 2004
97.
98.
Ioannidis JP, Evans SJ, Gotzsche PC, O'Neill RT, Altman DG, Schulz K, Moher D: Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med. 2004, 141: 781-788.CrossRefPubMed
99.
Dixon WG, Carmona L, Finckh A, Hetland ML, Kvien TK, Landewe R, Listing J, Nicola PJ, Tarp U, Zink A, Askling J: EULAR points to consider when establishing, analysing and reporting safety data of biologics registers in rheumatology. Ann Rheum Dis. 2010, 69: 1596-1602. 10.1136/ard.2009.125526.CrossRefPubMed
Metadata
Title
The association between systemic glucocorticoid therapy and the risk of infection in patients with rheumatoid arthritis: systematic review and meta-analyses
Authors
William G Dixon
Samy Suissa
Marie Hudson
Publication date
01-08-2011
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 4/2011
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/ar3453

Other articles of this Issue 4/2011

Arthritis Research & Therapy 4/2011 Go to the issue

Research article

Rates of, and risk factors for, severe infections in patients with systemic autoimmune diseases receiving biological agents off-label

Research article

Decreased catalytic function with altered sumoylation of DNA topoisomerase I in the nuclei of scleroderma fibroblasts

Review

Cytokine disturbances in systemic lupus erythematosus

Review

Positive regulators of osteoclastogenesis and bone resorption in rheumatoid arthritis

Meeting report

7th meeting of the global arthritis research network

Review

Lymphotoxin α revisited: general features and implications in rheumatoid arthritis
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits