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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1994 Apr;53(4):224–228. doi: 10.1136/ard.53.4.224

Infection rate and use of antibiotics in patients with rheumatoid arthritis treated with methotrexate.

M J van der Veen 1, A van der Heide 1, A A Kruize 1, J W Bijlsma 1
PMCID: PMC1005299  PMID: 8203949

Abstract

OBJECTIVE--To investigate prospectively the frequency and type of infections and the use of antibiotics among patients with rheumatoid arthritis (RA) on methotrexate (MTX) and patients with RA without MTX. METHODS--Every three months for one year 77 patients on MTX and 151 patients without MTX were asked about infections and the use of antibiotics by means of a standardised questionnaire. Medication was checked with the pharmacist. RESULTS--In the MTX group there were significantly more infections and more antibiotic therapy. The relative risks for patients on MTX of infection or antibiotics use were 1.52 (95% Confidence Interval (CI) 1.04-2.22) and 1.49 (95% CI 1.04-2.13), respectively. The relative risk of MTX for respiratory tract infections was 1.43 (95% CI 0.96-2.14) and for skin infections 2.19 (95% CI 1.45-3.31). The increased risks could only partly be explained by differences in disease severity and were not related to either duration of MTX therapy or use of prednisone. Three patients in the MTX group had herpes zoster versus one in the control group. CONCLUSIONS--Treatment with MTX increases the rate of infection and thus the use of antibiotics but does not lead to serious complications necessitating discontinuation of the drug.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altz-Smith M., Kendall L. G., Jr, Stamm A. M. Cryptococcosis associated with low-dose methotrexate for arthritis. Am J Med. 1987 Jul;83(1):179–181. doi: 10.1016/0002-9343(87)90517-1. [DOI] [PubMed] [Google Scholar]
  2. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  3. Clerc D., Brousse C., Mariette X., Bennet P., Bisson M. Cytomegalovirus pneumonia in a patient with rheumatoid arthritis treated with low dose methotrexate and prednisone. Ann Rheum Dis. 1991 Jan;50(1):67–67. doi: 10.1136/ard.50.1.67-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cornelissen J. J., Bakker L. J., Van der Veen M. J., Rozenberg-Arska M., Bijlsma J. W. Nocardia asteroides pneumonia complicating low dose methotrexate treatment of refractory rheumatoid arthritis. Ann Rheum Dis. 1991 Sep;50(9):642–644. doi: 10.1136/ard.50.9.642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kremer J. M., Phelps C. T. Long-term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis. Update after a mean of 90 months. Arthritis Rheum. 1992 Feb;35(2):138–145. doi: 10.1002/art.1780350203. [DOI] [PubMed] [Google Scholar]
  6. Perruquet J. L., Harrington T. M., Davis D. E. Pneumocystis carinii pneumonia following methotrexate therapy for rheumatoid arthritis. Arthritis Rheum. 1983 Oct;26(10):1291–1292. doi: 10.1002/art.1780261021. [DOI] [PubMed] [Google Scholar]
  7. Vandenbroucke J. P., Kaaks R., Valkenburg H. A., Boersma J. W., Cats A., Festen J. J., Hartman A. P., Huber-Bruning O., Rasker J. J., Weber J. Frequency of infections among rheumatoid arthritis patients, before and after disease onset. Arthritis Rheum. 1987 Jul;30(7):810–813. doi: 10.1002/art.1780300711. [DOI] [PubMed] [Google Scholar]
  8. Weinblatt M. E., Weissman B. N., Holdsworth D. E., Fraser P. A., Maier A. L., Falchuk K. R., Coblyn J. S. Long-term prospective study of methotrexate in the treatment of rheumatoid arthritis. 84-month update. Arthritis Rheum. 1992 Feb;35(2):129–137. doi: 10.1002/art.1780350202. [DOI] [PubMed] [Google Scholar]
  9. van Albada-Kuipers G. A., Linthorst J., Peeters E. A., Breedveld F. C., Dijkmans B. A., Hermans J., Vandenbroucke J. P., Cats A. Frequency of infection among patients with rheumatoid arthritis versus patients with osteoarthritis or soft tissue rheumatism. Arthritis Rheum. 1988 May;31(5):667–671. doi: 10.1002/art.1780310513. [DOI] [PubMed] [Google Scholar]

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