THU0145 INCIDENCE, TREND AND FACTORS ASSOCIATED WITH OPPORTUNISTIC INFECTION (OI) IN PATIENTS WITH RHEUMATOID ARTHRITIS IN SPAIN. (TREND-AR STUDY)
Authors: Ramón Mazzucchelli, María Velasco Arribas, Elia Perez-Fernandez, Alberto García-Vadillo, Natalia Crespí-Villarías
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The epidemiology of hospitalizations for Opportunistic Infections (OI) in patients with rheumatoid arthritis (RA) is unknown despite an increase in RA treatments that confer risk of infection. <h3>Objectives</h3> To analyze the incidence, trend and factors associated with hospitalizations due to OI in patients with RA, in Spain, during the period between 1999 and 2015. <h3>Methods</h3> Population study based on the analysis of a national administrative database that includes a Minimum Basic Data Set (MBDS) of the income of patients with RA (ICD 9 714). Period: January 1, 1999 to December 31, 2015. The following entities were included as OI: tuberculosis (tbc), nontuberculous mycobacteria, cytomegalovirus (CMV), Epstein-Barr virus (EBV), Herpes zoster (HZ), Candidiasis, Toxoplasmosis, Pneumocystosis, Cryptococcosis, Listeriosis, Nocardiosis, Aspergillosis, Coccidioidomycosis, Histoplasmosis, Blastomycosis, Strongyloides, Leishmaniosis, Cryptoporidium, Trypanosoma cruzi, JVC and other prion viruses. These diagnoses were identified by the presence in primary and secondary diagnosis of their ICD9 codes. The population at risk was estimated through the population census of the National Institute of Statistics, with an estimated prevalence of RA of 0.5% in both sexes (0.2% in men and 0.8% in women). Crude and adjusted rates were calculated at the national level. The trend was analyzed by Generalized Linear Models (GLM) using the year variable as the analysis variable. Clinical-demographic factors associated with these infections were analyzed, using uni and multivariate logistic regression. <h3>Results</h3> Of the total of 338,343 hospital admissions in patients with RA during the 17 years of the study period, there were 4,097 (1.2%) admissions with opportunistic infection, 1591 (38.8%) in men and 2506 (61.2%) in women (p &lt;0.001). The infections found in order of frequency were: HZ 1295 (29.9%), Tbc 1227 (29.9%), Aspergillosis 357 (8.7%), systemic candidiasis 342 (8.3%), CMV 270 (6.5%), EBV 133 (3.2%), Pneumocstosis 122 (2.9%), Leishmaniosis 100 (2.4%), Listeriosis 98 (2.3%), Mycobacteria no tbc 85 (2%), Nocardiosis 86 (2.1%), Trypansoma Cruzzi 19 (&lt;1%), JVC 19 (&lt;1%), Cryptococcosis 15 (&lt;1%), Toxoplasmosis 14 (&lt; 1%), Strongyloides 11 (&lt;1%), Cryptosporidium 6 (&lt;1%), Histoplasmosis 1 (&lt;10%), blastomycosis 1 (&lt;1%). Between 20-40 years the most frequent infections were: Tbc, EBV, CMV; Between 40-60 years: Tbc, HZ, CMV; Over 60 years old: HZ, tbc, aspergillus. The mean age was 65.54 (SD16.6). 445 (10.9%) died during admission; 217 (13.6%) in men and 228 (9.1%) in women (p &lt;0.001). The mean of the Charlson index was 1.96 (1.49), 2.21 (SD1.6) in men and 1.81 (SD1.3) in women (p &lt;0.001). The Relative Risk male: female was 2.77. The infections with the highest male/female RR were: Leishmaniosis (4.77), Listeriosis (4.1) and Aspergillosis (3.8). The infections with the highest lethality were: Pneumocystosis (31%), Candidiasis (29.8%) and Aspergillosis (27.7%). The age-adjusted rate for all OI was 146.21/100,000 inh*year, 297.05 in men and 107.37 in women. Adjusted IO rates increased from 85.47 in 1999, to 193.48 in 2015. It is estimated that this increase is of 4,96% per year. In the multivariate analysis, the factors associated with OI were: male, COPD and liver disease. <h3>Conclusion</h3> In Spain, during the period 1999 to 2015, there has been an increase in the incidence rate of OI in patients with RA. We estimate an annual increase of 4,9%. Being male and having COPD or liver disease are associated with OI. <h3>Disclosure of Interests</h3> None declared