Clinical Characteristics and Prognostic Factors of Pneumonia in Patients with and Without Rheumatoid Arthritis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Aug 4

PMID 30075013

Citations 6

Authors

Aya Wakabayashi

Takashi Ishiguro

Yotaro Takaku

Yosuke Miyahara

Naho Kagiyama

Noboru Takayanagi

Affiliations

Soon will be listed here.

Abstract

Background: To elucidate the characteristics of pneumonia in rheumatoid arthritis (RA) patients and to assess whether pneumonia in RA patients differs from that in non-RA patients.

Methods: We retrospectively divided pneumonia patients into two groups, those with RA and those without RA, and compared the two groups. We evaluated the risk factors for mortality with univariate and multivariate logistic regression analysis.

Results: Among 1549 patients, 71 had RA. The RA patients with pneumonia were 71.0±8.9 years old, 54.9% were female, 40.9% had a smoking history, and 71.8% had underlying respiratory disease. Female sex, non-smoker, and respiratory comorbidities were statistically more frequent in the RA patients than non-RA patients. The most frequent causative microbial agents of pneumonia in the RA patients were Streptococcus pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae, Mycoplasma pneumoniae, and influenza virus, whereas those of pneumonia in non-RA patients were S. pneumoniae, influenza virus, M. pneumoniae, Legionella spp., P. aeruginosa, H. influenzae, and Moraxella catarrhalis. Polymicrobial infection were identified as etiologies more frequently in the RA patients than non-RA patients. Although the severity of pneumonia did not differ between the two groups, mortality was statistically higher in the RA patients than non-RA patients. Multivariate analysis showed RA to be an independent risk factor for mortality.

Conclusions: P. aeruginosa, H. influenzae, M. catarrhalis, and polymicrobial infection were statistically more frequent etiologies of pneumonia in the RA patients than non-RA patients. RA itself was found to be an independent risk factor for mortality from pneumonia.

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References

Nakajima A, Inoue E, Tanaka E, Singh G, Sato E, Hoshi D . Mortality and cause of death in Japanese patients with rheumatoid arthritis based on a large observational cohort, IORRA. Scand J Rheumatol. 2010; 39(5):360-7. DOI: 10.3109/03009741003604542. View

Yelin E, Trupin L, Wong B, Rush S . The impact of functional status and change in functional status on mortality over 18 years among persons with rheumatoid arthritis. J Rheumatol. 2002; 29(9):1851-7. View

Widdifield J, Bernatsky S, Paterson J, Gunraj N, Thorne J, Pope J . Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012; 65(3):353-61. DOI: 10.1002/acr.21812. View

Baum J . Infection in rheumatoid arthritis. Arthritis Rheum. 1971; 14(1):135-7. DOI: 10.1002/art.1780140119. View

Radovits B, Fransen J, Al Shamma S, Eijsbouts A, Van Riel P, Laan R . Excess mortality emerges after 10 years in an inception cohort of early rheumatoid arthritis. Arthritis Care Res (Hoboken). 2010; 62(3):362-70. DOI: 10.1002/acr.20105. View

Blumentals W, Arreglado A, Napalkov P, Toovey S . Rheumatoid arthritis and the incidence of influenza and influenza-related complications: a retrospective cohort study. BMC Musculoskelet Disord. 2012; 13:158. PMC: 3495205. DOI: 10.1186/1471-2474-13-158. View

. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. DOI: 10.1164/rccm.200405-644ST. View

Mandell L, Wunderink R, Anzueto A, Bartlett J, Campbell G, Dean N . Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. PMC: 7107997. DOI: 10.1086/511159. View

Yousem S, Colby T, CARRINGTON C . Lung biopsy in rheumatoid arthritis. Am Rev Respir Dis. 1985; 131(5):770-7. DOI: 10.1164/arrd.1985.131.5.770. View

10.

Young A, Koduri G, Batley M, Kulinskaya E, Gough A, Norton S . Mortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis. Rheumatology (Oxford). 2006; 46(2):350-7. DOI: 10.1093/rheumatology/kel253. View

11.

Ishiguro T, Kagiyama N, Uozumi R, Odashima K, Kurashima K, Morita S . Risk factors for the severity and mortality of pneumococcal pneumonia: Importance of premorbid patients' performance status. J Infect Chemother. 2016; 22(10):685-91. DOI: 10.1016/j.jiac.2016.07.008. View

12.

Ishiguro T, Takayanagi N, Yamaguchi S, Yamakawa H, Nakamoto K, Takaku Y . Etiology and factors contributing to the severity and mortality of community-acquired pneumonia. Intern Med. 2013; 52(3):317-24. DOI: 10.2169/internalmedicine.52.8830. View

13.

Brown K . Rheumatoid lung disease. Proc Am Thorac Soc. 2007; 4(5):443-8. PMC: 2647595. DOI: 10.1513/pats.200703-045MS. View

14.

Vinogradova Y, Hippisley-Cox J, Coupland C . Identification of new risk factors for pneumonia: population-based case-control study. Br J Gen Pract. 2009; 59(567):e329-38. PMC: 2751937. DOI: 10.3399/bjgp09X472629. View

15.

Arnett F, Edworthy S, Bloch D, McShane D, Fries J, Cooper N . The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988; 31(3):315-24. DOI: 10.1002/art.1780310302. View

16.

Koetz K, Bryl E, Spickschen K, OFallon W, Goronzy J, Weyand C . T cell homeostasis in patients with rheumatoid arthritis. Proc Natl Acad Sci U S A. 2000; 97(16):9203-8. PMC: 16846. DOI: 10.1073/pnas.97.16.9203. View

17.

Wolfe F, Mitchell D, Sibley J, Fries J, Bloch D, Williams C . The mortality of rheumatoid arthritis. Arthritis Rheum. 1994; 37(4):481-94. DOI: 10.1002/art.1780370408. View

18.

Hakoda M, Oiwa H, Kasagi F, Masunari N, Yamada M, Suzuki G . Mortality of rheumatoid arthritis in Japan: a longitudinal cohort study. Ann Rheum Dis. 2005; 64(10):1451-5. PMC: 1755235. DOI: 10.1136/ard.2004.033761. View

19.

Tsuchiya Y, Takayanagi N, Sugiura H, Miyahara Y, Tokunaga D, Kawabata Y . Lung diseases directly associated with rheumatoid arthritis and their relationship to outcome. Eur Respir J. 2010; 37(6):1411-7. DOI: 10.1183/09031936.00019210. View

20.

Doran M, Crowson C, Pond G, OFallon W, Gabriel S . Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum. 2002; 46(9):2287-93. DOI: 10.1002/art.10524. View