More Bacterial Infection in Children With Juvenile Arthritis

The rates of hospitalization for bacterial infection are higher in children who have juvenile idiopathic arthritis (JIA) than in those who do not, according to an observational study. The risk of infection among patients with JIA was increased significantly with the use of high-dose corticosteroids, but the use of methotrexate (MTX) and tumor necrosis factor a (TNF-a) inhibitors did not increase the risk of infection in this patient population.

Beukelman and associates from the University of Alabama at Birmingham used US Medicaid data from 2000 to 2005 to compare the incidence of bacterial infection in children with and those without JIA. They identified 8479 patients who had JIA with 13,003 person-years of follow-up and 360,489 children with attention-deficit/hyperactivity disorder (ADHD) for comparison. The researchers used pharmacy claims to determine exposure to MTX, TNF-a inhibitors, and oral corticosteroids. They identified infections using hospital discharge diagnoses.

The researchers found a 2-fold increase in rates of hospitalization for bacterial infection in patients with JIA without current exposure to MTX or TNF-a inhibitors compared with patients with ADHD, even after adjusting for corticosteroid use; the finding suggested that the inflammatory or autoimmune process may predispose children to infection regardless of therapy. Among children with JIA, the rates of infection associated with MTX and TNF-a inhibitor use were similar. The researchers noted that corticosteroid-sparing treatment may reduce the risk of serious infection in children with JIA. The findings are reported in Arthritis Care & Research, an American College of Rheumatology publication.