High Infection Risk in Kids with RA

Juvenile rheumatoid arthritis patients have higher rates of bacterial infection

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) For many children with rheumatoid arthritis, drug treatment is one of the few ways to stop the pain. Some of these medications, however, may be raising patients' risk of infection.

Children with juvenile rheumatoid arthritis may have a higher risk of bacterial infection, compared to children without rheumatoid arthritis. The risk of infection may be even higher for patients taking steroids.

"Ask your child's doctor about the side effects of arthritis drugs."

Drugs like Rheumatrex (methotrexate), Trexall (methotrexate), TNF inhibitors, and steroids are commonly used to treat children with rheumatoid arthritis. Yet, researchers are still unclear about how these drugs influence the risk of infection.

For this reason, Timothy Beukelman, M.D., M.S.C.E., of the University of Alabama at Birmingham, and his research team compared the rates of bacterial infection in children with and without juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis is an inflammatory disease that causes pain, swelling, and stiffness around the joints. Over time, it can lead to disability. According to the American College of Rheumatology, nearly 300,000 American children suffer from the disease.

From their study, Dr. Beukelman and colleagues found that patients who were not taking methotrexate or TNF inhibitors were two times more likely to be hospitalized for bacterial infection compared to children without arthritis.

According to Dr. Beukelman, this finding may imply that characteristics of inflammatory arthritis may put children at risk of infection, no matter the drugs they are taking.

"This finding suggests the inflammatory or autoimmune process may predispose children to infection regardless of therapy," he says.

The researchers also found that arthritis patients taking high doses of steroids (at least 10 mg of prednisone per day) had more than twice the risk of infection compared patients not taking steroids.

"A steroid-sparing treatment strategy may reduce the risk of serious infection in children with [juvenile rheumatoid arthritis]," Dr. Beukelman concludes.

For their study, the researchers looked at Medicaid data from 2000 to 2005. They identified 8,479 children with juvenile rheumatoid arthritis. About 360,500 children with ADHD were used as a comparison group.

In order to treat their disease, 42 percent of juvenile rheumatoid arthritis patients used methotrexate and 17 percent used TNF inhibitors.

Support for this observational study came from grants from the Agency for Healthcare Research and Quality (AHRQ), the Food and Drug Administration (FDA), the U.S. Department of Health and Human Services (DHHS), and the National Institutes of Health (NIH).

The study is published in Arthritis & Rheumatism.

Reviewed by: 
Review Date: 
May 2, 2012
Last Updated:
June 6, 2012