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30-04-2012 | Immunology | Article

Children with juvenile arthritis have high bacterial infection risk


Free abstract

MedWire News: Children with juvenile idiopathic arthritis (JIA) have a high rate of serious bacterial infections compared with children without the condition, suggest study findings.

In children with JIA, high-dose corticosteroid, but not methotrexate or tumor necrosis factor alpha (TNF-α) inhibitor treatment appeared to increase the risk for such infections, say the researchers.

"Studies in adult patients have shown an increased risk for infection associated with rheumatoid arthritis (RA) compared to the general population and a positive association between infection risk and RA disease activity and severity," write Timothy Beukelman (The University of Alabama at Birmingham, USA) and colleagues in Arthritis and Rheumatism.

"However, it is not known if a similar infection risk increase exists among children with JIA," they add.

The researchers used US Medicaid data from 2000 to 2005 on 8479 children with JIA and a comparison group of 360,489 children with attention deficit hyperactivity disorder (ADHD).

The children were followed up for 13,003 person-years in total, during which time 30% of those with JIA were treated with oral glucocorticoids, 36% with methotrexate, and 16% with TNF inhibitors. In addition, 9.3% of the ADHD group used oral glucocorticoids during the follow-up period.

The team found that in comparison with ADHD patients, children with JIA had a significant two-fold increased risk for bacterial infection (upper respiratory tract, pneumonia, bacteremia/septicemia, urinary tract/pyelonephritis, skin and soft tissue, abdominal abscess, gastroenteritis).

"This finding suggests the inflammatory or autoimmune process may predispose children to infection regardless of therapy," said Beukelman in a press statement.

Children with JIA seemed to be particularly at risk for the more serious infections such as pneumonia, bacteremia/septicemia and urinary tract/pyelonephritis with rates of 24%, 18%, and 18%, respectively, over the follow-up period compared with a corresponding 20%, 12%, and 9% in children with ADHD.

When the investigators looked at children with JIA alone, they found that use of methotrexate or TNF inhibitors did not significantly increase the risk for bacterial infection compared with nonuse of these drugs.

However, high-dose glucocorticoid use (prednisolone ≥10 mg/day) significantly increased the risk for bacterial infection compared with nonuse by over three-fold.

"A steroid-sparing treatment strategy may reduce the risk of serious infection in children with JIA," suggested Beukelman.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Helen Albert

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