ArticleRheumatology (Oxford, England)2023
Glucocorticoid exposure and the risk of serious infections in rheumatoid arthritis: a marginal structural model application.
Article in Rheumatology (Oxford, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 15 citations in OpenAlex.
- Glucocorticoid use among patients with rheumatoid arthritis during the first year of treatment-a cohort study.Rheumatology international · 2026Article
- Development and validation of a risk score for serious infection in patients with rheumatic diseases receiving prolonged high-dose glucocorticoids.Arthritis research & therapy · 2026Article
- Insights Into Late-Onset Rheumatoid Arthritis (LORA): Characteristics (Clinical and Imaging), Comorbidities, and Therapeutic Targets.Geriatrics & gerontology international · 2026Review
- Systemic inflammation and extra-articular manifestations in rheumatoid arthritis: a cross-sectional study.Frontiers in medicine · 2026Article
- Serious infection risk in older adults with RA receiving biologic or targeted synthetic DMARDs: the role of age at disease onset.Therapeutic advances in musculoskeletal disease · 2026Article
- Risk of infection in patients with early inflammatory arthritis: results from a large UK prospective observational cohort study.Rheumatology (Oxford, England) · 2025Observational
- The impact of aging and glucocorticoid use on physical function of older rheumatoid arthritis in remission: analysis of a National Database of Rheumatic Disease in Japan.Clinical rheumatology · 2025Article
- Causal estimation of time-varying treatments in observational studies: a scoping review of methods, applications, and missing data practices.BMC medical research methodology · 2025Article
- Infections in Patients with Atopic Dermatitis and the Influence of Treatment.American journal of clinical dermatology · 2025Review
- Severe Respiratory Infections in Rheumatoid Arthritis Patients: An Observational Study of 528 Patients from a Single University Hospital.Journal of clinical medicine · 2025Article
- Quercetin as a therapeutic agent for acute pancreatitis: a comprehensive review of antioxidant, anti-inflammatory, and immunomodulatory mechanisms.Frontiers in pharmacology · 2025Review
- A Preliminary Survey of Rheumatologists on the Management of Late-onset Rheumatoid Arthritis in Japan.Internal medicine (Tokyo, Japan) · 2024Article
- Unmet Needs and Current Challenges of Rheumatoid Arthritis: Difficult-to-Treat Rheumatoid Arthritis and Late-Onset Rheumatoid Arthritis.Journal of clinical medicine · 2024Review
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveObservational studies have reported an increased risk of infections associated with glucocorticoids in RA, not supported by evidence from randomized controlled trials. Inappropriately accommodating time-varying exposure and confounding in observational studies might explain the conflicting results. Therefore, we compared the incidence of serious infections between different oral glucocorticoid dose patterns over three years in a prospective inception cohort, adjusting for time-varying confounders in marginal structural models.
methodsWe included 9654 newly diagnosed RA patients from the Swedish Rheumatology Quality Register between 2007-2018 and followed them for three years after the first rheumatology visit. Follow-up was divided into 90-day periods. A mean oral prednisone daily dose was calculated for each period and categorized into 'no use', 'low' (≤10 mg/day) and 'high' (>10 mg/day) doses. The incidence of serious infections (hospitalization for infection) over follow-up periods was modelled by pooled logistic regression allowing separate effects for recent and past exposure.
resultsAn increased incidence of serious infections was associated with higher compared with lower doses and with more recent compared with past glucocorticoid exposure. Over 3 years of follow-up, the marginal structural models predicted one additional serious infection for every 83 individuals treated with low GC doses for the first 6 months, and for every 125 individuals treated with high GC doses for the first 3 months, compared with no GC use.
conclusionOur results broadly agree with previous observational studies showing a dose dependent increased risk of infection associated with (recent) use of oral glucocorticoids.
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