Sarah K Brode1, Frances B Jamieson2, Ryan Ng3, Michael A Campitelli4, Jeffrey C Kwong5, J Michael Paterson6, Ping Li4, Alexandre Marchand-Austin7, Claire Bombardier8, Theodore K Marras9. 1. Joint Division of Respirology, University Health Network, Mount Sinai Hospital, Toronto; Westpark Healthcare Centre, Toronto; Department of Medicine, Management and Evaluation, University of Toronto, Toronto. 2. Department of Laboratory Medicine and Pathobiology, Management and Evaluation, University of Toronto, Toronto; Public Health Ontario, Toronto. 3. Department of Medicine, Management and Evaluation, University of Toronto, Toronto. 4. Institute for Clinical Evaluative Sciences, Toronto. 5. Department of Medicine and Toronto Western Family Health Team, University Health Network, Mount Sinai Hospital, Toronto; Department of Family and Community Medicine, Management and Evaluation, University of Toronto, Toronto; Public Health Ontario, Toronto; Institute for Clinical Evaluative Sciences, Toronto. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; Institute for Clinical Evaluative Sciences, Toronto; Department of Family Medicine, McMaster University, Hamilton. 7. Public Health Ontario, Toronto. 8. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto; Toronto General Hospital Research Institute, Toronto, ON, Canada. 9. Joint Division of Respirology, University Health Network, Mount Sinai Hospital, Toronto; Department of Medicine, Management and Evaluation, University of Toronto, Toronto. Electronic address: ted.marras@uhn.ca.
Abstract
OBJECTIVE: Patients with rheumatoid arthritis (RA) are at increased risk of TB. Little is known about the risk of nontuberculous mycobacteria (NTM) disease in these patients. We sought to ascertain the rate of NTM infection and TB in all residents of Ontario, Canada, with and without RA. METHODS: In a cohort study, all Ontarians aged ≥ 15 years in January 2001 were followed until December 2010. Individuals with RA were identified using a validated algorithm to search hospitalization and physician billing claims. We linked Public Health Ontario Laboratory data to identify all cases of laboratory-confirmed TB and NTM disease. Analysis was performed using Cox proportional hazards regression. RESULTS: We identified 113,558 Ontarians with RA and 9,760,075 Ontarians without RA. Relative to the non-RA group, adjusted hazard ratios (HRs) and 95% CIs for TB (1.92, [1.50-2.47]) and NTM disease (2.07, [1.84-2.32]) demonstrated increased risks in the RA group. Among those with RA, per 100,000 person-years, NTM disease (HR, 41.6; 95% CI, 37.1-46.5) was more common than TB (HR, 8.5; 95% CI, 6.5-10.8). After full adjustment, people with RA who developed NTM disease were 1.81 times as likely to die than uninfected people with RA. CONCLUSIONS: Mycobacterial infections are more common in Ontarians with RA, with NTM disease more likely than TB. NTM disease is associated with an increased risk of death in patients with RA. Given the rising rates of NTM disease worldwide, determining whether this risk is due to the use of immunosuppressive medications vs RA itself is an important objective for future research.
OBJECTIVE:Patients with rheumatoid arthritis (RA) are at increased risk of TB. Little is known about the risk of nontuberculous mycobacteria (NTM) disease in these patients. We sought to ascertain the rate of NTM infection and TB in all residents of Ontario, Canada, with and without RA. METHODS: In a cohort study, all Ontarians aged ≥ 15 years in January 2001 were followed until December 2010. Individuals with RA were identified using a validated algorithm to search hospitalization and physician billing claims. We linked Public Health Ontario Laboratory data to identify all cases of laboratory-confirmed TB and NTM disease. Analysis was performed using Cox proportional hazards regression. RESULTS: We identified 113,558 Ontarians with RA and 9,760,075 Ontarians without RA. Relative to the non-RA group, adjusted hazard ratios (HRs) and 95% CIs for TB (1.92, [1.50-2.47]) and NTM disease (2.07, [1.84-2.32]) demonstrated increased risks in the RA group. Among those with RA, per 100,000 person-years, NTM disease (HR, 41.6; 95% CI, 37.1-46.5) was more common than TB (HR, 8.5; 95% CI, 6.5-10.8). After full adjustment, people with RA who developed NTM disease were 1.81 times as likely to die than uninfected people with RA. CONCLUSIONS:Mycobacterial infections are more common in Ontarians with RA, with NTM disease more likely than TB. NTM disease is associated with an increased risk of death in patients with RA. Given the rising rates of NTM disease worldwide, determining whether this risk is due to the use of immunosuppressive medications vs RA itself is an important objective for future research.
Authors: Mehdi Mirsaeidi; Maham Farshidpour; Mary Beth Allen; Golnaz Ebrahimi; Joseph O Falkinham Journal: Biomed Res Int Date: 2014-09-11 Impact factor: 3.411
Authors: Theodore K Marras; Michael A Campitelli; Hong Lu; Hannah Chung; Sarah K Brode; Alex Marchand-Austin; Kevin L Winthrop; Andrea S Gershon; Jeffrey C Kwong; Frances B Jamieson Journal: Emerg Infect Dis Date: 2017-03 Impact factor: 6.883