High-dose steroids in­crease bac­te­rial in­fec­tion in chil­dren with ju­ve­nile arthri­tis

Wellness Update - - Contents -

BIRM­ING­HAM, Ala. – Chil­dren with ju­ve­nile id­io­pathic arthri­tis have higher rates of bac­te­rial in­fec­tion re­quir­ing hos­pi­tal­iza­tion, and use of high-dose steroids sig­nif­i­cantly in­creases that risk, ac­cord­ing to re­search from the Univer­sity of Alabama at Birm­ing­ham. In find­ings pub­lished in Arthri­tis & Rheuma­tism, the jour­nal of the Amer­i­can Col­lege of Rheuma­tol­ogy, the re­searchers show that steroid use led to in­creased risk, while other com­monly used med­i­ca­tions — methotrex­ate and tu­mor ne­cro­sis fac­tor in­hibitors — did not in­crease in­fec­tion risk in chil­dren with JIA. “Among chil­dren with JIA, ques­tions have per­sisted about a pos­si­ble in­creased risk of se­ri­ous in­fec­tions as­so­ci­ated with the use of TNF in­hibitors, one of the so-called bi­o­log­ics which have be­come in­creas­ingly pop­u­lar as a treat­ment for JIA,” said Ti­mothy Beukel­man, M.D., MSCE, as­so­ci­ate pro­fes­sor of pe­di­atric rheuma­tol­ogy and sci­en­tist in the UAB Center for Clin­i­cal and Trans­la­tional Sci­ence. “But the re­la­tion­ship be­tween JIA and se­ri­ous bac­te­rial in­fec­tions has not been ex­ten­sively stud­ied and is not well un­der­stood.” Beukel­man’s team set out to an­swer sev­eral ques­tions. They wanted to know the in­fec­tion rates for chil­dren with JIA in gen­eral, along with the rates for chil­dren whose disease was man­aged by methotrex­ate, TNF in­hibitors and steroids known as oral glu­co­cor­ti­coids, another com­monly used treat­ment. “This find­ing sug­gests the in­flam­ma­tory or au­toim­mune process it­self may pre­dis­pose chil­dren to in­fec­tion re­gard­less of ther­apy,” said Beukel­man. Beukel­man’s group also found that the in­fec­tion rate among JIA pa­tients was not any higher in chil­dren treated with ei­ther methotrex­ate or TNF in­hibitors, but that the rate was sig­nif­i­cantly higher in those chil­dren treated with high-dose glu­co­cor­ti­coids. “The use of a high dose of glu­co­cor­ti­coid, more than 10 mg of pred­nisone daily, was con­sis­tently as­so­ci­ated with a dou­bling of the in­fec­tion rate,” Beukel­man said. “This strongly in­di­cates that a treat­ment strat­egy that lim­its steroid use may re­duce the risk of se­ri­ous in­fec­tion in chil­dren with JIA.” Arthri­tis is an in­flam­ma­tion of the joints that causes pain, swelling, stiff­ness and can lead to dis­abil­ity. JIA is the most com­mon type of childhood arthri­tis and may af­fect 300,000 chil­dren in the United States, ac­cord­ing to the Amer­i­can Col­lege of Rheuma­tol­ogy.

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