Infections in RA

Widdifield, J., Bernatsky, S., Paterson, J. M., Gunraj, N., Thorne, J. C., Pope, J., Cividino, A. and Bombardier, C. (2013), Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res, 65: 353–361. doi: 10.1002/acr.21812

Our results emphasize that many RA drugs may increase the risk of infection, but glucocorticoids appear to confer a particular risk.

I regularly see non-rheumatologists stop DMARD therapy and replace it with steroids due to concerns for infection. I recently had a hospitalist stop my patient's MTX and start 60mg of daily prednisone due to infection concerns.

We need to make sure we are educating our non-rheumatologist colleagues that although they may be more comfortable with steroids, that doesn't mean the infection risk is lower.

Knowing the risk of one medication doesn't mean that not knowing the risks of another makes it the safer alternative. I also see this with NSAIDs. Yes, they have a CV risk profile, but so do narcotics. Switching from the former to the later for knee-jerk "CV concerns" is not rationale.