According to an observational study published in Arthritis & Rheumatism, children with juvenile idiopathic arthritis (JIA) have higher rates of hospitalized bacterial infection compared with those without JIA.

The study demonstrates that the risk of infection in JIA patients was considerably higher with use of high-dose glucocorticoids (steroids). However, methotrexate (MTX) and tumor necrosis factor alpha (TNF) inhibitors did not increase the risk of infection in these pediatric patients.

Arthritis is an inflammation of the joints that is usually accompanied by pain, stiffness and swelling and can lead to disability.

There are numerous forms of arthritis, but JIA is a chronic arthritis disease that attacks young patients. According to the American College of Rheumatology (ACR) JIA affects almost 300,000 children in the U.S. JIA is commonly treated with immunosuppressant therapies like steroids, MTX, and TNF inhibitors. However, it remains uncertain how these drugs affect the risk of infection.

Dr. Timothy Beukelman from the University of Alabama at Birmingham, USA and his team decided to compare bacterial infection incidence in children with and without JIA. Using Medicaid data from 2000 to 2005, they identified 8,479 JIA patients with 13,003 person-years of follow-up and a group of 360,489 children with attention-deficit hyperactivity disorder (ADHD) for comparison. To determine exposure to MTX, TNF inhibitors and oral steroid medications, the team used pharmacy claims and diagnoses on hospital discharges in order to identify infections.

The team observed that 42% of JIA patients used MTX and 17% used TNF inhibitors to manage their disease. They noted that JIA patients who were currently not taking MTX or TNF inhibitors had an elevated rate of bacterial infection compared to ADHD patients. The results remained unchanged even after adjusting for steroid use.

Dr. Beukelman explains:

“Patients with JIA who were not currently treated with MTX or TNF inhibitors had a 2-fold increase in hospitalized bacterial infection rates compared to children without arthritis. This finding suggests the inflammatory or autoimmune process may predispose children to infection regardless of therapy.”

The rate of infection linked to MTX or TNF inhibitors was similar amongst children with JIA. After the team adjusted for MTX and TNF inhibitor use in children with JIA, the team discovered that high-dose steroid use, i.e. 10 mg or more of prednisone per day resulted in more than double the rate of subsequent infection compared to those who did not take steroids.

Dr. Beukelman says in a concluding statement:

“A steroid-sparing treatment strategy may reduce the risk of serious infection in children with JIA.”

Written By Petra Rattue