Patients with polymyalgia rheumatica and/or giant cell arteritis who take oral steroids are at a significantly greater risk of infection, and the risk increases with higher doses, according to a study in CMAJ journal.
A study in England of approximately 40,000 patients with polymyalgia rheumatica or giant cell arteritis found higher absolute risks of infection when patients were taking oral steroids than when they were not taking them. Steroids included prednisolone, prednisone, hydrocortisone, and cortisone. The risk of infection was greater at higher doses but it was also elevated with low daily doses of less than 5 mg of prednisolone.
According to the researchers, during periods of prescribed medication use, the patients’ risk for infection was 50% higher than when medication was not prescribed. Those increases ranged from 48% for fungal infections to 70% for bacterial infections.
More than half of study patients (56%), whose mean age was 73 years, had infections during 138,412 person-years of follow up. The most common were lower respiratory tract infections (27%), conjunctivitis (9%) and shingles (7%). Twenty-seven percent of patients were admitted to the hospital and 7% died within one week of the infection diagnosis.
Patients and clinicians should be aware of the risk of infection, educated about symptom identification, prompt treatment, and timely vaccination, and document any history of chronic infection such as herpes zoster, say the study authors.
The authors also suggest that dose–response estimates could be helpful for assessing new glucocorticoid-sparing drugs for patients who have these inflammatory conditions.
Source: EurekAlert!, June 24, 2019