Infections induced by low-dose corticosteroids in rheumatoid arthritis: A systematic literature review

Objective: To study the association between infection risk and low-dose corticosteroids (LD-CT, defined as a daily dose < 10 mg/day of prednisone) in rheumatoid arthritis (RA). Methods: Data source: a systematic review of the literature up to June 2009 was performed. Data extraction :all type of infections: bacterial, viral and postoperative; infection severity. RA activity, RA severity, comorbid conditions. Data analysis: descriptive, comparing infection risk between LD-CT-treated and LD-CT-not treated RA. Results: Of the 1310 screened reports, the literature analysis identified 15 assessing infection risk of LD-CT in RA patients. Of the eight reports that studied all types of infection, six articles found no association between risk of infection and LD-CT, one showed an association between severe infections and LD-CT (OR = 8 [1-64]) and another showed a dose-dependent association including doses of less than 5 mg/day: RR = 1.32 [1.06-1.63] and doses between 6 to 10 mg/day: RR = 1.95 [1.53-2.46]. Of the three trials that studied infection risk secondary to bacteria, one showed an increased risk (HR = 1.7 [1.5-2.0]) while two did not (respectively, exposure to < 5 mg/day: OR = 1.34[0.85-2.13]; 6 to 9 mg/day: OR = 1.53 [0.95-2.48] and < 5 mg/day: OR = 1.49 [0.82-2.72]; 5 to 10 mg/day: OR = 1.46 [0.84-2.54]). None of the three trials studying postoperative infection risk found any association between infection risk and LD-CT treatment. Two reports studied herpes zoster risk and found no association with LD-CT. Conclusion: There was a paucity of data about LD-CT and infection risk in RA and that risk seems poorly increased. These findings need to be confirmed by further studies. (C) 2010 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.