Immunosuppressive Medications and Nonserious Infections in People With Rheumatoid Arthritis: A Prospective Cohort Study

OBJECTIVE: People with rheumatoid arthritis (RA) are at increased risk of serious infection, but less is known about nonserious infections. Our prospective cohort study evaluated associations between medications for RA and the risk of nonserious infections. METHODS: We remotely recruited adults with RA in a community rheumatology practice-based research network. Participants joined the ArthritisPower Registry (now PatientSpot) and completed a baseline and up to six monthly follow-up surveys. Using data from consecutive monthly surveys, we assessed associations between medication use at the prior survey and infection report at the subsequent survey, adjusting for confounders. RESULTS: We recruited 351 people with RA (mean age 60, 84% female) who reported 439 infections (330 infections per 100 patient-years). Associations between medication use and infection were assessed among 1,075 qualifying observations with 289 (27%) total infections and 146 (14%) infections with health care encounters or antibiotic use. Compared to those receiving conventional synthetic disease-modifying antirheumatic drugs who were biologic or JAK inhibitor (JAKi) naïve, current biologic or JAKi use was not associated with either infection outcome. Infections were numerically more common with glucocorticoids ≥10 mg/day (odds ratio 1.94, 95% confidence interval 0.89-4.24). Season, previous infection, poorer function, and rural residence were significantly associated with one or both infection outcomes. CONCLUSION: Biologics and JAKi were not associated with greater risk for nonserious infections compared to conventional therapies. Given that nonserious infection risk may be due more to exposures and general health status, future studies should assess whether the common practice of interrupting medications in people with infection improves or worsens outcomes.