Impact of non-serious infections on medication interruptions, quality of life, and disease flares in patients with rheumatoid arthritis.

Abstract

OBJECTIVES Patients with rheumatoid arthritis (RA) are at an increased risk for serious infections, but less is known about more common, non-serious infections. We aimed to assess the frequency and characteristics of non-serious infections and their effect on medication interruptions, quality of life, and disease flares. METHODS We remotely recruited adults with RA from July 2022 to July 2023 through a community rheumatology practice-based research network. Participants joined the ArthritisPower Registry (now PatientSpot) and completed a baseline survey and up to 6 monthly follow-up surveys, focused on patient-reported outcomes (PROs), infections, medication interruptions, and disease flares. The impact of infections was evaluated by comparing survey measures in those with vs without an infection. RESULTS We recruited 351 patients with RA who contributed 1674 monthly observations. Patients reported 523 infections (31% of observations), most frequently upper respiratory infections. Although few infections led to emergency department visits or hospitalizations, infections frequently led to missed work (37%) or RA treatment interruptions (26%). RA treatment interruptions were more common in those with vs without healthcare encounters or antibiotic use (38% vs 12%) and in more severe vs less severe infections (47% vs 20%). Infections were associated with worse scores for PROMIS Fatigue but not PROMIS Function, Depression, or Ability to Participate Socially. Frequency of disease flares was greater in those with an infection who interrupted RA treatment, especially in patients receiving tumor necrosis factor inhibitors. CONCLUSION Infections are common in patients with RA and frequently lead to medication interruptions. These infections are associated with greater fatigue and impaired work productivity and may contribute to more disease flares.