Adolescent/Child Health

Children with juvenile idiopathic arthritis are at high risk of hospital stays that involve bacterial infections

Children with juvenile idiopathic arthritis (JIA) have been significantly helped with biologic agents, such as tumor necrosis factor alpha (TNF) inhibitors. Unfortunately, a side effect of these drugs, which suppress the immune system (and thus inflammation related to arthritis), can be an increased risk of infection. A new study reveals that children with JIA do have a higher rate of infection than that experienced by children with attention deficit hyperactivity disorder (ADHD). However, the use of TNF inhibitors or methotrexate (MTX) did not further increase the rate of hospital stays that involved bacterial infections. Infection rates were, however, significantly higher in patients taking 10 mg or more of prednisone daily or a comparable amount of another glucocorticoid.
Using Medicaid data, the researchers identified 8,479 children with JIA. The patients were younger than 16 years and suffered from any of the entities that comprised JIA (for example, psoriatic arthritis, ankylosing spondylitis, or arthritis associated with inflammatory bowel disease). For comparison, the researchers used a group of children who suffered from ADHD but did not have JIA. Among children with JIA not being treated with TNF inhibitors or MTX the rate of hospital stays that involved bacterial infections was twice that of the children without JIA. No additional risk of infection was found with the use of MTX, a longstanding treatment for JIA, or with TNF inhibitors. However, the children with JIA who took high doses of prednisone were three times as likely to have a hospital stay with a bacterial infection as were the arthritis patients who took no glucocorticoids.
The findings suggest that the inflammatory or autoimmune processes present in JIA may increase the risk of infection in these children regardless of the therapy used. The study was supported in part by the Agency for Healthcare Research and Quality (HS17919).
See "Rates of hospitalized bacterial infection associated with juvenile idiopathic arthritis and its treatment," by Timothy Beukelman, M.D., M.S.C.E., Fenglong Xie, M.S., Lang Chen, Ph.D., and others in the August 2012 Arthritis & Rheumatism 64(8), pp. 2773-2780.

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