TNF-alpha Inhibitors Increase Risk of Septic Arthritis in Rheumatoid Arthritis Patients

A study has found that TNF-alpha inhibitors increase the risk of septic arthritis in patients with rheumatoid arthritis. TNF-alpha inhibitors have been used for patients with chronic inflammatory arthritis. A research team led by Professor Seongsu Ahn from the Department of Rheumatology at Yonsei University College of Medicine, Yongin Severance Hospital, Professor Hyungwoo Kim from the Department of Nephrology at Severance Hospital, and Professor Minkyeong Han from the Department of Biomedical Systems Informatics at Yonsei University College of Medicine recently announced these findings. The study results were published in the international journal Rheumatology.

Professor Seongsu An, Department of Rheumatology, Yonsei University College of Medicine, Yongin Severance Hospital (from the left), Professor Hyungwoo Kim, Department of Nephrology, Severance Hospital, Professor Minkyeong Han, Department of Biomedical Systems Informatics, Yonsei University College of Medicine

Ankylosing spondylitis and rheumatoid arthritis are the most common chronic inflammatory arthritis conditions occurring in adults. Traditionally, treatment has mainly involved the use of conventional synthetic disease-modifying antirheumatic drugs (DMARDs). Recently, with increased understanding of disease pathogenesis, treatment that inhibits TNF-alpha, a key substance that induces inflammation, has been commonly implemented for patients who do not respond sufficiently to existing therapies. However, concerns have been raised that continuous use of such immunosuppressive treatments may increase the risk of septic arthritis due to abnormalities in the normal immune system.

Septic arthritis is difficult to distinguish from joint swelling and pain caused by exacerbation of chronic inflammatory diseases, and if not properly treated, it can be life-threatening, requiring careful attention. The research team conducted a study to assess the risk of septic arthritis after TNF-alpha inhibitor treatment in patients with ankylosing spondylitis and seropositive rheumatoid arthritis. For the study, data from 145,129 patients diagnosed with ankylosing spondylitis or seropositive rheumatoid arthritis were selected from the Health Insurance Review and Assessment Service database.

After excluding patients with a prior history of these diseases, the team analyzed the proportion of patients diagnosed with septic arthritis during the follow-up period and examined risk factors. The study found that septic arthritis occurred in 1,170 patients, accounting for 0.8% of the total. Notably, only in seropositive rheumatoid arthritis patients was the use of TNF-alpha inhibitors associated with an increased risk of septic arthritis. Risk factors increasing the risk of septic arthritis in seropositive rheumatoid arthritis patients included the use of TNF-alpha inhibitors, age, and underlying conditions such as hypertension, diabetes, and chronic lung disease. In ankylosing spondylitis patients, only age and a history of kidney disease were associated with septic arthritis.

Furthermore, in both diseases, the risk of septic arthritis was highest within one year of starting TNF-alpha inhibitor treatment. When examining the entire patient group with ankylosing spondylitis and seropositive rheumatoid arthritis, advanced age, male sex, diagnosis of seropositive rheumatoid arthritis, underlying conditions such as hypertension, diabetes, chronic lung disease, and use of TNF-alpha inhibitors were identified as risk factors for septic arthritis. Professor Seongsu Ahn explained, "This study is significant in revealing that the use of TNF-alpha inhibitors increases the risk of septic arthritis depending on factors such as age, underlying diseases, and elapsed time after starting medication, suggesting that careful consideration of these risk factors is necessary for patients using these drugs in the future."

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