Evidence map›Paper›PMID 40471746›Full record

Observational studyRheumatology (Oxford, England)2025

Risk of infection in patients with early inflammatory arthritis: results from a large UK prospective observational cohort study.

Maryam A Adas, Katie Bechman, Mark D Russell, Victoria Allen, Samir Patel, Mark Gibson, Ioasaf Karafotias, Kathryn Biddle, Benjamin Zuckerman, Kaiyang Song and 12 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Rheumatology (Oxford, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Maryam A AdasCentre for Rheumatic Disease, King's College London, London, UK.ORCID 0000-0002-5560-6603
Katie BechmanCentre for Rheumatic Disease, King's College London, London, UK.
Mark D RussellCentre for Rheumatic Disease, King's College London, London, UK.ORCID 0000-0001-8171-7772
Victoria AllenCentre for Rheumatic Disease, King's College London, London, UK.
Samir PatelCentre for Rheumatic Disease, King's College London, London, UK.
Mark GibsonCentre for Rheumatic Disease, King's College London, London, UK.
Ioasaf KarafotiasCentre for Rheumatic Disease, King's College London, London, UK.
Kathryn BiddleCentre for Rheumatic Disease, King's College London, London, UK.ORCID 0000-0001-5267-200X
Benjamin ZuckermanCentre for Rheumatic Disease, King's College London, London, UK.ORCID 0000-0002-0077-6074
Kaiyang SongCentre for Rheumatic Disease, King's College London, London, UK.
Deepak NagraCentre for Rheumatic Disease, King's College London, London, UK.ORCID 0000-0002-1307-6528
Edward AlveynCentre for Rheumatic Disease, King's College London, London, UK.
Suma MahendrakarCentre for Rheumatic Disease, King's College London, London, UK.
Meryem NursoyCentre for Rheumatic Disease, King's College London, London, UK.
Fabiola AtzeniCentre for Rheumatic Disease, King's College London, London, UK.
Sarah GallagherNEIAA, British Society for Rheumatology, London, UK.
Elizabeth PriceNEIAA, British Society for Rheumatology, London, UK.ORCID 0000-0003-3042-0201
Mark GartonRheumatology Department, The Shrewsbury and Telford Hospital NHS Trust, Shropshire, UK.
Andrew RutherfordRheumatology Department, King's College Hospital, London, UK.ORCID 0000-0002-5183-7965
Andrew P CopeCentre for Rheumatic Disease, King's College London, London, UK.
Sam NortonCentre for Rheumatic Disease, King's College London, London, UK.ORCID 0000-0003-1714-9963
James B GallowayCentre for Rheumatic Disease, King's College London, London, UK.ORCID 0000-0002-1230-2781

Funding

AbbVie
6 · The paper itself

Abstract

objectiveTo identify risk of serious infections (SI) according to initial conventional synthetic DMARDs (csDMARD) and CS, in patients recruited to the National Early Inflammatory Arthritis Audit.

methodsAn observational cohort study was used, including adults in England and Wales with new diagnoses of RA between 2018 and 2023. The main outcome was SI events, defined as infections requiring hospitalization/or resulting in death. Secondary analyses evaluated SI-related mortality alone. Hazard ratios (HR) were calculated using cox proportional hazards models. Primary predictor was initial treatment strategy, with confounder adjustments.

resultsA total of 17 472 patients were included, of whom 10 997 were on MTX-based strategies, 4540 on other csDMARDs and 13 680 received CS. There were 1307 SI events, corresponding to incidence rates (IR) per 100 person-years of 3.02 (95% CI 2.86-3.19) and 311 cases of SI-related mortality (IR 0.69, 95% CI 0.61-0.77). MTX-based strategies were associated with reduced risk of SI events compared with other csDMARDs (adjusted HR 0.72, 95% CI 0.63-0.82). In unadjusted models, CS was associated with higher risk of SI events, but in adjusted models this association was no longer significant (adjusted HR 0.99, 95% CI 0.87-1.12). Increasing age, being a current/or ex-smoker (relative to non-smoker), having a comorbidity, being seropositive and having high DAS based on 28 joint count (DAS28) were all associated with increased incidence of SI. One unit increase in baseline DAS28 increases the risk of SI event by 10%.

conclusionMTX-based regimens associated with a reduced risk of SI compared with other strategies. Patient-level and disease-related factors at diagnosis are important predictors of SI in individuals with new RA.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidInfectionsAdultAgedFemaleHumansIncidenceMaleMethotrexateMiddle AgedProspective StudiesRisk FactorsUnited KingdomWalesAntirheumatic AgentsMethotrexatecorticosteroidscsDMARDsearly rheumatoid arthritisinfectioninitial treatment strategymethotrexatemortalityrheumatoid arthritisserious infections

Identifiers

PMID40471746
PMCPMC12596073

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.