Confirmation that daily steroid treatment for RA increases risk of serious infections

Low-dose steroids are commonly used for the management of rheumatoid arthritis (RA), despite the fact that these agents are commonly associated with serious adverse effects including significant infections. A recently published retrospective cohort study has assessed the incidence of infection associated with long-term use of low-dose glucocorticoids for people RA receiving stable disease-modifying antirheumatic drug (DMARD) treatment. Associations were stratified by steroid dose (none, ≤5 mg/d, >5 to 10 mg/d, and >10 mg/d) and hospitalized infection were evaluated using inverse probability–weighted analyses, with 1-year cumulative incidence predicted from weighted models. RA patients receiving stable DMARD therapy and glucocorticoids were displayed a dose-dependent increase in the risk for serious infection, with small but significant risks even at doses of 5 mg or less per day. The increase in relative risk at daily doses > 10 mg was more pronounced, and the researchers advocate for increased prescriber awareness of this significant clinical issue. See the original paper here