Oral Steroids Increase Infection Risk in Inflammatory Disease

The incidence of infection increases with glucocorticoid dose for patients with polymyalgia rheumatica or giant cell arteritis, according to a study published online June 24 in CMAJ, the journal of the Canadian Medical Association.

Jianhua Wu, Ph.D., from the University of Leeds in the United Kingdom, and colleagues conducted a retrospective record-linkage study involving 39,938 patients with polymyalgia rheumatica or giant cell arteritis. The dose-response risks for infection were estimated.

The researchers found that during a median follow-up period of 4.8 years, 55.7 percent of patients had at least one infection, with 26.7 percent requiring hospital admission and 7.3 percent dying within seven days of diagnosis. The cumulative risks of all-cause infection were 18.3, 54.7, and 76.9 percent at one, five, and 10 years, respectively. The increases in adjusted hazard ratios for all-cause infection were 1.13 per 5-mg prednisolone-equivalent daily dose increase, and 1.50 per 1,000-mg cumulative dose increase in the last year from the patient's end date of follow-up. The adjusted hazard ratios associated with current glucocorticoid use versus no glucocorticoid use varied from 1.48 to 1.70 for fungal and bacterial infection, respectively. For bacterial, viral, parasitic, and fungal infections, stepwise dose-related associations were identified.

"Patients and clinicians should be educated about the risk of infection, need for symptom identification, prompt treatment, timely vaccination, and documentation of history of chronic infection," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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