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Original research
Prognosis of pneumonia in patients with rheumatoid arthritis: the role of medication and disease activity prior to admission a population-based cohort study
  1. Mette Holland-Fischer1,
  2. Reimar W Thomsen2,
  3. Ulrik Tarp3 and
  4. Mette Nørgaard2
  1. 1Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
  2. 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  3. 3Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Dr Mette Holland-Fischer; mhf{at}


Objective Patients with rheumatoid arthritis (RA) experience an increased risk of infections, but the prognosis of infections is unclear. We examined if patients with RA have worse outcomes from pneumonia than non-RA individuals.

Methods In a population-based cohort study, we computed 90-day mortality rates and crude and adjusted HRs comparing pneumonia patients with and without RA. Among patients with RA, we evaluated prognostic effects of RA medications including prednisolone and disease activity as assessed by C reactive protein (CRP) or platelet levels measured 30–180 days before admission to avoid any influence from the subsequent infection.

Results Among 52 577 patients hospitalised for the first time with pneumonia, 1220 (2.3%) had RA. The 90-day mortality was 19.9% for patients with RA and 18.9% for non-RA patients (adjusted 90-day HR of 1.05 (95% CI 0.92 to 1.19)). Compared with CRP levels <8 mg/L, CRP levels ≥20 mg/L predicted increased mortality in patients with RA with adjusted 90-day HRs of 4.98 (95% CI 2.19 to 11.36). Compared with methotrexate monotherapy, both prednisolone (HR 1.43 (95% CI 0.91 to 2.22)) and no RA therapy (HR 1.35 (95% CI 0.85 to 2.14)) tended to increase 90-day mortality. Compared with patients who used prednisolone and had low CRP levels, high CRP predicted increased mortality both in patients who used prednisolone (HR 3.09, 95% CI 1.25 to 7.65) and those who did not (HR 2.35, 95% CI 0.94 to 5.87).

Conclusions Overall, RA does not increase mortality following hospitalisation for pneumonia. However, high RA disease activity prior to admission predicts increased pneumonia mortality in patients regardless of prednisolone use.

  • DMARDs (synthetic)
  • DMARDs (biologic)
  • disease activity
  • infections
  • rheumatoid arthritis

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  • Contributors All authors have made substantial contributions to study design, and participated in the acquisition and interpretation of data. MH-F analysed the data and wrote the first draft. All authors have participated in the revision of the manuscript. All authors have approved the version published.

  • Funding The study received an unrestricted grant from The Danish Rheumatism Association (Gigtforeningen), grant number A2225.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Danish Data Protection Agency (record number 2013-41-2663). Approval by an ethics committee was not required according to Danish legislation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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