medwireNews: High rheumatoid arthritis (RA) disease activity is associated with an increased risk for pneumonia-related mortality regardless of prednisolone use, suggest findings from a Danish cohort study.
Among 52,577 patients admitted to hospital with pneumonia for the first time, 90-day mortality rates were comparable for the 1220 individuals with RA and the 51,357 without, at 19.9% and 18.9%, respectively, indicating that “[o]verall, RA does not increase mortality [risk] following hospitalisation for pneumonia,” report the study authors.
However, Mette Holland-Fischer (Aalborg University Hospital) and colleagues identified a significant association between high disease activity and mortality risk among the RA patients; high C-reactive protein (CRP) levels (≥20 mg/L) were associated with a significant 3.64-fold increased risk for 30-day mortality and a significant 4.91-fold increased risk for 90-day mortality relative to low CRP levels (<8 mg/L) after adjustment for factors including age, sex, comorbidities, and prednisolone use.
And when RA patients were categorized according to prednisolone use, high CRP levels significantly predicted pneumonia mortality risk in patients who were (adjusted hazard ratio [HR]=3.09) and were not taking prednisolone (adjusted HR=2.35), when patients with low CRP levels not using prednisolone were used as the comparator group.
Moreover, “[r]eassuringly, treatment with biologics and [conventional] DMARDs, either as a monotherapy or in combination, did not predict increased pneumonia mortality,” report the researchers.
Together, these results indicate that “high RA disease activity per se is an important prognostic factor in patients with RA with pneumonia and should be controlled,” they conclude in RMD Open.
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