Why are RA Seniors at Higher Risk of Serious Infections?

Canadian doctors have warned that the wellbeing of seniors with rheumatoid arthritis (RA) is at risk, as they are significantly more likely to develop serious infections that could be overlooked. RA is a serious inflammatory condition that affects the wellness of roughly 4% of seniors, making them more vulnerable to infections, such as pneumonia, which can lead to hospitalisation.

Experts have estimated that if 100 seniors with rheumatoid arthritis were followed for one year, five would be hospitalised for an infection. Using hospital administrative data, McGill University researchers, who published their work in the journal Arthritis Care & Research, compared infections in RA patients in Ontario over age 66 with other people with rheumatoid arthritis of the same age and sex who weren’t diagnosed with a first infection.

Dr Sasha Bernatsky, a professor in the rheumatology and clinical epidemiology divisions at McGill University in Montreal, reported ‘Our findings were interesting on a couple of different levels.’ She explained that people with RA and other chronic health problems such as chronic lung disease and kidney disease were at increased risk of infection, and therefore when patients have these conditions, it’s a strong signal that doctors should keep a close watch on them.

She continued, ‘When it came to medication exposures, there were several of these immune suppressing drugs that seem to be associated with an increased risk of infection. But where the dramatic risk was really was for our oldest drug which is prednisone.’ This drug is often the first used to tackle infection, but as it decreases immune activity in people with RA, Bernatsky urged that it should be prescribed at the lowest possible dose for the shortest time. To a lesser degree than prednisone, disease modifying medications such as methotrexate and newer biologics also seemed to be associated with increased risk of infection.

According to Bernatsky, the results of the study have already made her more cautious in trying to taper people to lower doses of prednisone. However, she also said that patients shouldn’t shy away from trying other medications, as doctors are more aware of the risks associated with the newest drugs, whereas the risks of prednisone may no longer be top of mind. If you are a senior with RA, Bernatsky added that the best way to treat infection is with prevention, suggesting that you try to avoid some infections by getting vaccinated against the flu and strains of pneumonia.