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Incidence of septic arthritis in patients with ankylosing spondylitis and seropositive rheumatoid arthritis following TNF inhibitor therapy

 Hyung Woo Kim  ;  Minkyung Han  ;  Inkyung Jung  ;  Sung Soo Ahn 
 RHEUMATOLOGY, Vol.62(8) : 2740-2747, 2023-08 
Journal Title
Issue Date
Adalimumab / therapeutic use ; Antibodies, Monoclonal, Humanized / therapeutic use ; Antirheumatic Agents* / adverse effects ; Arthritis, Infectious* / drug therapy ; Arthritis, Rheumatoid* / drug therapy ; Arthritis, Rheumatoid* / epidemiology ; Etanercept / adverse effects ; Humans ; Incidence ; Infliximab / adverse effects ; Male ; Receptors, Tumor Necrosis Factor ; Spondylitis, Ankylosing* / drug therapy ; Spondylitis, Ankylosing* / epidemiology ; Tumor Necrosis Factor Inhibitors / adverse effects ; Tumor Necrosis Factor-alpha
AS ; TNF ; biologics ; septic arthritis ; seropositive RA
Objectives: Septic arthritis (SA) is a serious complication occurring in the joints, and its risk increases with immunosuppressive therapy. This study investigated whether TNF inhibitors increase the risk of SA in patients with AS and seropositive RA (SPRA).

Methods: We searched the South Korean Health Insurance Review and Assessment Service database for incident cases of AS and SPRA between 2010 and 2020. SA was defined using the diagnostic code M00 and hospital admission. Cox-proportional hazards analysis was conducted to compare the incidence of SA according to TNF inhibitor (infliximab, etanercept, adalimumab/golimumab) use during follow-up.

Results: Of the 145 129 patients analysed, 1170 (0.8%) developed SA during the follow-up period. Older age; male sex; SPRA diagnosis; comorbidities of hypertension (HTN), diabetes mellitus (DM) and chronic pulmonary disease (CPD); and infliximab and etanercept use increased the incidence of SA in the overall population. However, in patients with AS, only age and renal disease were predictors of SA, and TNF inhibitors did not increase the incidence of SA. Meanwhile, patients with SPRA treated with TNF inhibitors were prone to SA regardless of TNF inhibitor type, and age, HTN, DM and CPD were associated with SA. The incidence of SA was prominent after the first year of commencing TNF inhibitor therapy, for both AS and SPRA.

Conclusion: TNF inhibitors increase the incidence of SA, specifically in patients with SPRA, but not AS. Importantly, age, comorbidities and the early time period after starting TNF inhibitors were associated with SA, which should be considered simultaneously when initiating TNF inhibitor therapy.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyung Woo(김형우) ORCID logo https://orcid.org/0000-0002-6305-452X
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-9002-9880
Jung, Inkyung(정인경) ORCID logo https://orcid.org/0000-0003-3780-3213
Han, Minkyung(한민경) ORCID logo https://orcid.org/0000-0002-5011-5557
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