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Haematological abnormalities in new onset rheumatoid arthritis and risk of common infections: a population-based study

Nikiphorou, Elena; de Lusignan, Simon; Mallen, Christian; Khavandi, Kaivan; Roberts, Jacqueline; Buckley, Christopher D.; Galloway, James; Raza, Karim

Haematological abnormalities in new onset rheumatoid arthritis and risk of common infections: a population-based study Thumbnail


Authors

Elena Nikiphorou

Simon de Lusignan

Kaivan Khavandi

Jacqueline Roberts

Christopher D. Buckley

James Galloway

Karim Raza



Abstract

Objectives To describe the prevalence of haematological abnormalities in individuals with rheumatoid arthritis (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 6,591 individuals with newly diagnosed RA between 2004 and 2016 inclusive using the UK Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. The prevalence of haematological abnormalities at diagnosis (anaemia, neutropenia and lymphopenia) was established. Cox proportional hazards models were used to evaluate i) the association between each haematological abnormality and time to common infections; ii) 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), neutropenia (0.6%) and lymphopenia (1.4%) less so. Lymphopenia and anaemia were associated with increased infection risk (respective hazard ratios (HR) 1.18 (95%CI 1.08-1.29); HR 1.37 (95%CI 1.08-1.73)). 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.

Journal Article Type Article
Acceptance Date Jun 23, 2019
Online Publication Date Sep 9, 2019
Publication Date 2020-05
Publicly Available Date Mar 29, 2024
Journal Rheumatology
Print ISSN 1462-0324
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 59
Issue 5
Pages 997-1005
DOI https://doi.org/10.1093/rheumatology/kez344
Keywords Rheumatoid arthritis; Anaemia; Lymphopenia; Neutropenia; Infection; Influenza; Influenza Vaccine; Pneumococcal Vaccine
Publisher URL http://doi,org/10.1093/rheumatology/kez344

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