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Severe extraarticular manifestations in a community based cohort of patients with rheumatoid arthritis : Risk factors and incidence in relation to treatment with tumor necrosis factor inhibitors

Theander, Lisa LU ; Nyhäll-Wahlin, Britt Marie; Nilsson, Jan-Åke LU ; Willim, Minna LU ; Jacobsson, Lennart T.H. LU ; Petersson, Ingemar F. LU and Turesson, Carl LU (2017) In Journal of Rheumatology 44(7). p.981-987
Abstract

Objective. The aims of this study were to evaluate whether treatment with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) affects the risk of developing severe extraarticular rheumatoid arthritis (ExRA) manifestations and to investigate potential predictors for developing ExRA. Methods. A dynamic community-based cohort of patients with RA was studied (n = 1977). Clinical records were reviewed and cases of severe ExRA were identified. Information on exposure to TNF inhibitors was obtained from a regional register. Exposure to TNF inhibitors was analyzed in a time-dependent fashion and the incidence of severe ExRA in exposed patients was compared with the incidence in unexposed patients. Cox regression... (More)

Objective. The aims of this study were to evaluate whether treatment with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) affects the risk of developing severe extraarticular rheumatoid arthritis (ExRA) manifestations and to investigate potential predictors for developing ExRA. Methods. A dynamic community-based cohort of patients with RA was studied (n = 1977). Clinical records were reviewed and cases of severe ExRA were identified. Information on exposure to TNF inhibitors was obtained from a regional register. Exposure to TNF inhibitors was analyzed in a time-dependent fashion and the incidence of severe ExRA in exposed patients was compared with the incidence in unexposed patients. Cox regression models were used to assess potential predictors of severe ExRA. Results. During treatment with TNF inhibitors, there were 17 patients with new onset of severe ExRA in 2400 person-years at risk (PY; 0.71/100 PY, 95% CI 0.41-1.13) compared with 104 in 15,599 PY (0.67/100 PY, 95% CI 0.54-0.81) in patients without TNF inhibitors. This corresponded to an incidence rate ratio of 1.06 (95% CI 0.60-1.78). The age-and sex-adjusted HR for ExRA in anti-TNF-treated patients was 1.21 (95% CI 1.02-1.43), with similar findings in models adjusted for time-dependent Health Assessment Questionnaire and propensity for anti-TNF treatment. Male sex, positive rheumatoid factor (RF), long disease duration, and greater disability were predictors for ExRA. Conclusion. This study suggests that patients treated with TNF inhibitors are at a slightly increased risk of developing severe ExRA. RF-positive patients with disabling disease of long duration were more likely to develop severe ExRA.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Extraarticular manifestations, Interstitial lung disease, Rheumatoid arthritis, TNF inhibitors, Vasculitis
in
Journal of Rheumatology
volume
44
issue
7
pages
7 pages
publisher
J Rheumatol Publ Co
external identifiers
  • scopus:85021834150
  • wos:000405601900005
ISSN
0315-162X
DOI
10.3899/jrheum.161103
language
English
LU publication?
yes
id
1d53c9ef-8564-4343-816b-27a8f50e0e16
date added to LUP
2017-07-26 10:12:24
date last changed
2018-08-05 04:43:13
@article{1d53c9ef-8564-4343-816b-27a8f50e0e16,
  abstract     = {<p>Objective. The aims of this study were to evaluate whether treatment with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) affects the risk of developing severe extraarticular rheumatoid arthritis (ExRA) manifestations and to investigate potential predictors for developing ExRA. Methods. A dynamic community-based cohort of patients with RA was studied (n = 1977). Clinical records were reviewed and cases of severe ExRA were identified. Information on exposure to TNF inhibitors was obtained from a regional register. Exposure to TNF inhibitors was analyzed in a time-dependent fashion and the incidence of severe ExRA in exposed patients was compared with the incidence in unexposed patients. Cox regression models were used to assess potential predictors of severe ExRA. Results. During treatment with TNF inhibitors, there were 17 patients with new onset of severe ExRA in 2400 person-years at risk (PY; 0.71/100 PY, 95% CI 0.41-1.13) compared with 104 in 15,599 PY (0.67/100 PY, 95% CI 0.54-0.81) in patients without TNF inhibitors. This corresponded to an incidence rate ratio of 1.06 (95% CI 0.60-1.78). The age-and sex-adjusted HR for ExRA in anti-TNF-treated patients was 1.21 (95% CI 1.02-1.43), with similar findings in models adjusted for time-dependent Health Assessment Questionnaire and propensity for anti-TNF treatment. Male sex, positive rheumatoid factor (RF), long disease duration, and greater disability were predictors for ExRA. Conclusion. This study suggests that patients treated with TNF inhibitors are at a slightly increased risk of developing severe ExRA. RF-positive patients with disabling disease of long duration were more likely to develop severe ExRA.</p>},
  author       = {Theander, Lisa and Nyhäll-Wahlin, Britt Marie and Nilsson, Jan-Åke and Willim, Minna and Jacobsson, Lennart T.H. and Petersson, Ingemar F. and Turesson, Carl},
  issn         = {0315-162X},
  keyword      = {Extraarticular manifestations,Interstitial lung disease,Rheumatoid arthritis,TNF inhibitors,Vasculitis},
  language     = {eng},
  month        = {07},
  number       = {7},
  pages        = {981--987},
  publisher    = {J Rheumatol Publ Co},
  series       = {Journal of Rheumatology},
  title        = {Severe extraarticular manifestations in a community based cohort of patients with rheumatoid arthritis : Risk factors and incidence in relation to treatment with tumor necrosis factor inhibitors},
  url          = {http://dx.doi.org/10.3899/jrheum.161103},
  volume       = {44},
  year         = {2017},
}