Risk of infection in patients with early inflammatory arthritis: results from a large UK prospective observational cohort study
Authors' conclusion
MTX-based regimens associated with a reduced risk of SI compared with other strategies. Patient-level and disease-related factors at diagnosis are important predictors of SI in individuals with new RA.
Study context
- Population
- Adults in England and Wales with new diagnoses of RA, 2018–2023, recruited to the National Early Inflammatory Arthritis Audit1,307 serious infections (SI) events
- Participants
- 17,472 adults
- Exposure
- MTX-based strategies vs other csDMARDs; CS vs no CS
- MTX-basedn = 10,997
- Other csDMARDsn = 4,540reference
- Outcome
- SI events: infections requiring hospitalization or resulting in death
Methodological detailsCox proportional hazards models, confounder-adjusted
- Cox proportional hazards models
- Confounder-adjusted
Main finding
As reported in the abstract
SI events
Each group vs other csDMARDsAdjusted hazard ratio (95% CI)
MTX-based
0.72(0.63–0.82)
CShigher risk in unadjusted models; no longer significant after adjustment
0.99(0.87–1.12)
- SI events, overall
- 1307
- SI incidence rates (IR) per 100 person-years
- 3.02 (95% CI 2.86-3.19)
Observational data: associations, not effects.
Further findings
SI-related mortality
- Cases
- 311
- IR per 100 person-years
- 0.69 (95% CI 0.61-0.77)
Predictors of SI
- Increase in SI risk per one-unit increase in baseline DAS28
- 10%
- Increasing age, current/ex-smoking, comorbidity, seropositivity and high DAS28 associated with increased SI incidence
Original publication
Risk of infection in patients with early inflammatory arthritis: results from a large UK prospective observational cohort study. Rheumatology (Oxford). Published 5 June 2025. doi:10.
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