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Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada
Objective To determine the risk of tuberculosis (TB) among a cohort of patients with rheumatoid arthritis (RA) in Quebec and assess whether this risk is associated with exposure to nonbiologic disease‐modifying antirheumatic drugs (DMARDs). Methods We studied a cohort of patients with RA identified...
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Published in: | Arthritis and rheumatism 2009-03, Vol.61 (3), p.300-304 |
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creator | Brassard, Paul Lowe, Anne‐Marie Bernatsky, Sasha Kezouh, Abbas Suissa, Samy |
description | Objective
To determine the risk of tuberculosis (TB) among a cohort of patients with rheumatoid arthritis (RA) in Quebec and assess whether this risk is associated with exposure to nonbiologic disease‐modifying antirheumatic drugs (DMARDs).
Methods
We studied a cohort of patients with RA identified from the Quebec provincial physician billing and hospitalization databases for 1980–2003. TB incidence rates were determined for the period 1992–2003 and compared with the general population, standardized for age and sex using the standardized incidence ratio (SIR). Conditional logistic regression was used in a nested case–control analysis to estimate the rate ratio (RR) of TB related to nonbiologic DMARD exposure during the year before the index date.
Results
Of the 24,282 patients with RA in the cohort, 50 cases of TB were identified. The standardized incidence rate was 45.8 cases per 100,000 person‐years compared with 4.2 cases per 100,000 person‐years in the general population of Quebec (SIR 10.9, 95% confidence interval [95% CI] 7.9–15.0). The adjusted RR of TB was 2.4 (95% CI 1.1–5.4) with corticosteroid use and 3.0 (95% CI 1.6–5.8) with nonbiologic DMARD use.
Conclusion
The age‐ and sex‐standardized incidence rate of TB in RA patients is 10 times that of the general population. At least some of this risk may be related to nonbiologic DMARD and corticosteroid therapies. Our data support the role of TB screening before initiation of any immunosuppressive therapy. |
doi_str_mv | 10.1002/art.24476 |
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To determine the risk of tuberculosis (TB) among a cohort of patients with rheumatoid arthritis (RA) in Quebec and assess whether this risk is associated with exposure to nonbiologic disease‐modifying antirheumatic drugs (DMARDs).
Methods
We studied a cohort of patients with RA identified from the Quebec provincial physician billing and hospitalization databases for 1980–2003. TB incidence rates were determined for the period 1992–2003 and compared with the general population, standardized for age and sex using the standardized incidence ratio (SIR). Conditional logistic regression was used in a nested case–control analysis to estimate the rate ratio (RR) of TB related to nonbiologic DMARD exposure during the year before the index date.
Results
Of the 24,282 patients with RA in the cohort, 50 cases of TB were identified. The standardized incidence rate was 45.8 cases per 100,000 person‐years compared with 4.2 cases per 100,000 person‐years in the general population of Quebec (SIR 10.9, 95% confidence interval [95% CI] 7.9–15.0). The adjusted RR of TB was 2.4 (95% CI 1.1–5.4) with corticosteroid use and 3.0 (95% CI 1.6–5.8) with nonbiologic DMARD use.
Conclusion
The age‐ and sex‐standardized incidence rate of TB in RA patients is 10 times that of the general population. At least some of this risk may be related to nonbiologic DMARD and corticosteroid therapies. Our data support the role of TB screening before initiation of any immunosuppressive therapy.</description><identifier>ISSN: 0004-3591</identifier><identifier>ISSN: 0893-7524</identifier><identifier>EISSN: 1529-0131</identifier><identifier>EISSN: 1529-0123</identifier><identifier>DOI: 10.1002/art.24476</identifier><identifier>PMID: 19248128</identifier><identifier>CODEN: ARCREG</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Aged ; Antirheumatic Agents - adverse effects ; Arthritis, Rheumatoid - drug therapy ; Arthritis, Rheumatoid - immunology ; Bacterial diseases ; Biological and medical sciences ; Canada - epidemiology ; Case-Control Studies ; Cohort Studies ; Diseases of the osteoarticular system ; Female ; Human bacterial diseases ; Humans ; Immunocompromised Host ; Immunosuppressive Agents - adverse effects ; Incidence ; Infectious diseases ; Inflammatory joint diseases ; Male ; Medical sciences ; Middle Aged ; Mycobacterium ; Risk ; Tuberculosis - epidemiology ; Tuberculosis and atypical mycobacterial infections</subject><ispartof>Arthritis and rheumatism, 2009-03, Vol.61 (3), p.300-304</ispartof><rights>Copyright © 2009 by the American College of Rheumatology</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4826-9c4cc4dccd97c6b97968c64cdbecdb19ef8d872ce63061be577ae0830afd5443</citedby><cites>FETCH-LOGICAL-c4826-9c4cc4dccd97c6b97968c64cdbecdb19ef8d872ce63061be577ae0830afd5443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27900,27901</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21213088$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19248128$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brassard, Paul</creatorcontrib><creatorcontrib>Lowe, Anne‐Marie</creatorcontrib><creatorcontrib>Bernatsky, Sasha</creatorcontrib><creatorcontrib>Kezouh, Abbas</creatorcontrib><creatorcontrib>Suissa, Samy</creatorcontrib><title>Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada</title><title>Arthritis and rheumatism</title><addtitle>Arthritis Rheum</addtitle><description>Objective
To determine the risk of tuberculosis (TB) among a cohort of patients with rheumatoid arthritis (RA) in Quebec and assess whether this risk is associated with exposure to nonbiologic disease‐modifying antirheumatic drugs (DMARDs).
Methods
We studied a cohort of patients with RA identified from the Quebec provincial physician billing and hospitalization databases for 1980–2003. TB incidence rates were determined for the period 1992–2003 and compared with the general population, standardized for age and sex using the standardized incidence ratio (SIR). Conditional logistic regression was used in a nested case–control analysis to estimate the rate ratio (RR) of TB related to nonbiologic DMARD exposure during the year before the index date.
Results
Of the 24,282 patients with RA in the cohort, 50 cases of TB were identified. The standardized incidence rate was 45.8 cases per 100,000 person‐years compared with 4.2 cases per 100,000 person‐years in the general population of Quebec (SIR 10.9, 95% confidence interval [95% CI] 7.9–15.0). The adjusted RR of TB was 2.4 (95% CI 1.1–5.4) with corticosteroid use and 3.0 (95% CI 1.6–5.8) with nonbiologic DMARD use.
Conclusion
The age‐ and sex‐standardized incidence rate of TB in RA patients is 10 times that of the general population. At least some of this risk may be related to nonbiologic DMARD and corticosteroid therapies. Our data support the role of TB screening before initiation of any immunosuppressive therapy.</description><subject>Aged</subject><subject>Antirheumatic Agents - adverse effects</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Arthritis, Rheumatoid - immunology</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>Canada - epidemiology</subject><subject>Case-Control Studies</subject><subject>Cohort Studies</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Immunocompromised Host</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Incidence</subject><subject>Infectious diseases</subject><subject>Inflammatory joint diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mycobacterium</subject><subject>Risk</subject><subject>Tuberculosis - epidemiology</subject><subject>Tuberculosis and atypical mycobacterial infections</subject><issn>0004-3591</issn><issn>0893-7524</issn><issn>1529-0131</issn><issn>1529-0123</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqF0VtLHDEUB_BQKnW1fegXKHlpRXA0t8nlURZvIIiy70MmOcOmzkWTDOK3b7a71KfqUzjw4384-SP0nZJTSgg7szGfMiGU_IQWtGamIpTTz2hBCBEVrw3dRwcp_S4j4zX_gvapYUJTphdo9bCGebB5Ch6XmHUMOaQTHHLCOYLNA4y5zHb0OK8Bx5Ae8dThPLcQ3dxPKSQcRnw_QwvuBC_taL39ivY62yf4tnsP0eryYrW8rm7vrm6W57eVE5rJyjjhnPDOeaOcbI0yUjspnC9RvqUGOu21Yg4kJ5K2UCtlgWhObOdrIfghOtrGPsXpeYaUmyEkB31vR5jm1CghKSfayCJ_vSulIoQrbT6EjAgha0YLPN5CF6eUInTNUwyDja8NJc2mlKb8ZvO3lGJ_7ELndgD_JnctFPBzB2xytu-iHV1I_xyjbHPHxp1t3Uvo4fX_G5vzh9V29R-fkaLo</recordid><startdate>20090315</startdate><enddate>20090315</enddate><creator>Brassard, Paul</creator><creator>Lowe, Anne‐Marie</creator><creator>Bernatsky, Sasha</creator><creator>Kezouh, Abbas</creator><creator>Suissa, Samy</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20090315</creationdate><title>Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada</title><author>Brassard, Paul ; Lowe, Anne‐Marie ; Bernatsky, Sasha ; Kezouh, Abbas ; Suissa, Samy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4826-9c4cc4dccd97c6b97968c64cdbecdb19ef8d872ce63061be577ae0830afd5443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Antirheumatic Agents - adverse effects</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Arthritis, Rheumatoid - immunology</topic><topic>Bacterial diseases</topic><topic>Biological and medical sciences</topic><topic>Canada - epidemiology</topic><topic>Case-Control Studies</topic><topic>Cohort Studies</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Immunocompromised Host</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Incidence</topic><topic>Infectious diseases</topic><topic>Inflammatory joint diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mycobacterium</topic><topic>Risk</topic><topic>Tuberculosis - epidemiology</topic><topic>Tuberculosis and atypical mycobacterial infections</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brassard, Paul</creatorcontrib><creatorcontrib>Lowe, Anne‐Marie</creatorcontrib><creatorcontrib>Bernatsky, Sasha</creatorcontrib><creatorcontrib>Kezouh, Abbas</creatorcontrib><creatorcontrib>Suissa, Samy</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Arthritis and rheumatism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brassard, Paul</au><au>Lowe, Anne‐Marie</au><au>Bernatsky, Sasha</au><au>Kezouh, Abbas</au><au>Suissa, Samy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada</atitle><jtitle>Arthritis and rheumatism</jtitle><addtitle>Arthritis Rheum</addtitle><date>2009-03-15</date><risdate>2009</risdate><volume>61</volume><issue>3</issue><spage>300</spage><epage>304</epage><pages>300-304</pages><issn>0004-3591</issn><issn>0893-7524</issn><eissn>1529-0131</eissn><eissn>1529-0123</eissn><coden>ARCREG</coden><abstract>Objective
To determine the risk of tuberculosis (TB) among a cohort of patients with rheumatoid arthritis (RA) in Quebec and assess whether this risk is associated with exposure to nonbiologic disease‐modifying antirheumatic drugs (DMARDs).
Methods
We studied a cohort of patients with RA identified from the Quebec provincial physician billing and hospitalization databases for 1980–2003. TB incidence rates were determined for the period 1992–2003 and compared with the general population, standardized for age and sex using the standardized incidence ratio (SIR). Conditional logistic regression was used in a nested case–control analysis to estimate the rate ratio (RR) of TB related to nonbiologic DMARD exposure during the year before the index date.
Results
Of the 24,282 patients with RA in the cohort, 50 cases of TB were identified. The standardized incidence rate was 45.8 cases per 100,000 person‐years compared with 4.2 cases per 100,000 person‐years in the general population of Quebec (SIR 10.9, 95% confidence interval [95% CI] 7.9–15.0). The adjusted RR of TB was 2.4 (95% CI 1.1–5.4) with corticosteroid use and 3.0 (95% CI 1.6–5.8) with nonbiologic DMARD use.
Conclusion
The age‐ and sex‐standardized incidence rate of TB in RA patients is 10 times that of the general population. At least some of this risk may be related to nonbiologic DMARD and corticosteroid therapies. Our data support the role of TB screening before initiation of any immunosuppressive therapy.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>19248128</pmid><doi>10.1002/art.24476</doi><tpages>5</tpages></addata></record> |
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subjects | Aged Antirheumatic Agents - adverse effects Arthritis, Rheumatoid - drug therapy Arthritis, Rheumatoid - immunology Bacterial diseases Biological and medical sciences Canada - epidemiology Case-Control Studies Cohort Studies Diseases of the osteoarticular system Female Human bacterial diseases Humans Immunocompromised Host Immunosuppressive Agents - adverse effects Incidence Infectious diseases Inflammatory joint diseases Male Medical sciences Middle Aged Mycobacterium Risk Tuberculosis - epidemiology Tuberculosis and atypical mycobacterial infections |
title | Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada |
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