Elena Nikiphorou1, Simon de Lusignan2,3, Christian Mallen4, Kaivan Khavandi5, Jacqueline Roberts5, Christopher D Buckley6,7,8, James Galloway9, Karim Raza6,8,10. 1. Department of Inflammation Biology, King's College London & Department of Rheumatology, King's College Hospital, London. 2. Department of Clinical and Experimental Medicine, University of Surrey, Guildford. 3. Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London. 4. Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele. 5. Pfizer Medical Affairs, Inflammation & Immunology, Pfizer Innovative Health, Tadworth, Surrey. 6. Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham. 7. Kennedy Institute of Rheumatology, University of Oxford, Oxford. 8. Research into Inflammatory Arthritis Centre Versus Arthritis, and the MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham. 9. Centre for Rheumatic Diseases, King's College London, Denmark Hill, London. 10. Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Abstract
OBJECTIVES: To describe the prevalence of haematological abnormalities in individuals with RA at the point of diagnosis in primary care and the associations between haematological abnormalities, vaccinations and subsequent risk of common infections. METHODS: We studied 6591 individuals with newly diagnosed RA between 2004 and 2016 inclusive using the UK Royal College of General Practitioners Research and Surveillance Centre primary care database. The prevalence of haematological abnormalities at diagnosis (anaemia, neutropenia and lymphopenia) was established. Cox proportional hazards models were used to evaluate the association between each haematological abnormality and time to common infections and the influence of vaccination status (influenza and pneumococcal vaccine) on time to common infections in individuals with RA compared with a matched cohort of individuals without RA. RESULTS: Anaemia was common at RA diagnosis (16.1% of individuals), with neutropenia (0.6%) and lymphopenia (1.4%) less so. Lymphopenia and anaemia were associated with increased infection risk [hazard ratio (HR) 1.18 (95% CI 1.08, 1.29) and HR 1.37 (95% CI 1.08, 1.73), respectively]. There was no evidence of an association between neutropenia and infection risk [HR 0.94 (95% CI 0.60, 1.47)]. Pneumonia was much more common in individuals with early RA compared with controls. Influenza vaccination was associated with reduced risk of influenza-like illness only for individuals with RA [HR 0.58 (95% CI 0.37, 0.90)]. CONCLUSION: At diagnosis, anaemia and lymphopenia, but not neutropenia, increase the risk of common infections in individuals with RA. Our data support the effectiveness of the influenza vaccination in individuals with RA.
OBJECTIVES: To describe the prevalence of haematological abnormalities in individuals with RA at the point of diagnosis in primary care and the associations between haematological abnormalities, vaccinations and subsequent risk of common infections. METHODS: We studied 6591 individuals with newly diagnosed RA between 2004 and 2016 inclusive using the UK Royal College of General Practitioners Research and Surveillance Centre primary care database. The prevalence of haematological abnormalities at diagnosis (anaemia, neutropenia and lymphopenia) was established. Cox proportional hazards models were used to evaluate the association between each haematological abnormality and time to common infections and the influence of vaccination status (influenza and pneumococcal vaccine) on time to common infections in individuals with RA compared with a matched cohort of individuals without RA. RESULTS:Anaemia was common at RA diagnosis (16.1% of individuals), with neutropenia (0.6%) and lymphopenia (1.4%) less so. Lymphopenia and anaemia were associated with increased infection risk [hazard ratio (HR) 1.18 (95% CI 1.08, 1.29) and HR 1.37 (95% CI 1.08, 1.73), respectively]. There was no evidence of an association between neutropenia and infection risk [HR 0.94 (95% CI 0.60, 1.47)]. Pneumonia was much more common in individuals with early RA compared with controls. Influenza vaccination was associated with reduced risk of influenza-like illness only for individuals with RA [HR 0.58 (95% CI 0.37, 0.90)]. CONCLUSION: At diagnosis, anaemia and lymphopenia, but not neutropenia, increase the risk of common infections in individuals with RA. Our data support the effectiveness of the influenza vaccination in individuals with RA.
Authors: Andrea Rubbert-Roth; Daniel E Furst; Stefano Fiore; Amy Praestgaard; Vivian Bykerk; Clifton O Bingham; Christina Charles-Schoeman; Gerd Burmester Journal: Arthritis Res Ther Date: 2022-08-25 Impact factor: 5.606
Authors: James Galloway; Kevin Barrett; Peter Irving; Kaivan Khavandi; Monica Nijher; Ruth Nicholson; Simon de Lusignan; Maya H Buch Journal: RMD Open Date: 2020-09