Glucocorticoid discontinuation may prevent infection in older RA patients

For older patients with rheumatoid arthritis (RA) who are receiving glucocorticoids (GCs), stopping its use lowers the incidence of infection, according to a study.

Researchers looked at the medical records of patients with RA who were ≥60 years of age to determine the association between GC use and the incidence of infection. The participants were grouped into three, according to GC use: GC-continued, GC-discontinued, and non-GC. Patient treatments and comorbidities were also examined.

A total of 389 patients with RA were included in the analysis, of which 122 were in the GC-discontinued group, 126 were in the GC-continued group, and 141 were in the non-GC group.

Infection occurred in 65 patients (16.7 percent), with the incidence being significantly higher in the GC-continued group than in the GC-discontinued (p=0.021) and non-GC (p=0.0003) groups. The incidence of infection was similar in the non-GC and GC-discontinued groups (p=0.659).

However, discontinuing GC was associated with a higher likelihood of requiring biologic use throughout the disease course as compared with the continued use or nonuse of GCs.

Significantly more patients in the GC-continued group than in the GC-discontinued group had comorbidities (p=0.007), especially malignancies (p=0.004).

The findings confirm that old age and GC use increase the susceptibility to infection in patients with RA. As such, the researchers highlighted the importance of GC discontinuation. They also called for further investigation into factors that help reduce GC use.