Risk of Non-serious Infections in Patients with Rheumatoid Arthritis

Sarfaroj Khan 


April 15, 2021


  • Non-serious infection (NSI) events were common in patients with rheumatoid arthritis (RA), with predictors similar to those for serious infections.

  • Biologics were associated with a greater risk of NSIs, with differences between therapies.

Why this matters

  • Findings will guide clinicians in identifying patients with RA at a greater risk of NSIs and selecting the best possible drug strategies.

Study design

  • The British Society for Rheumatology Biologics Register-Rheumatoid Arthritis (BSRBR-RA) study is a national prospective observational cohort study (n=23,584) initiated in 2001 to monitor the long-term safety of biologics.

  • Primary outcome: NSI reported to the BSRBR-RA by either the clinical team or the patient.

  • Funding: None.

Key results

  • During the 3-year follow-up period, 17,304 NSI episodes were reported in 8145 patients with RA, corresponding to 27.0 (95% CI, 26.6-27.4) NSI events per 100 patient-years of follow-up.

  • The risk of NSIs increased with (adjusted HR [aHR]; 95% CI):

    • age (1.03; 1.01-1.05; P<.01);

    • gender (1.61; 1.51-1.71; P<.001);

    • higher rheumatic disease comorbidity index (1.11; 1.09-1.13; P<.001);

    • steroid therapy (1.25; 1.19-1.32; P<.001); and

    • higher Disease Activity Score 28 (1.15; 1.13-1.18) and Health Assessment Questionnaire-Disability Index score (1.34; 1.29-1.39; P<.001).

  • Compared with tumour necrosis factor inhibitors (TNFis), interleukin-6 inhibitors (aHR, 1.45; 95% CI, 1.29-1.63; P<.001) and rituximab (aHR, 1.28; 95% CI, 1.14-1.45; P<.001) were associated with an increased risk of NSIs.

  • Conventional synthetic disease-modifying anti-rheumatic drugs were associated with a lower risk of NSIs (aHR, 0.64; 95% CI, 0.59-0.70; P<.001).

  • Within the TNFi class, adalimumab vs etanercept was associated with an increased risk of NSIs (aHR, 1.11; 95% CI, 1.05-1.17; P<.001).



Bechman K, Halai K, Yates M, Norton S, Cope AP, Hyrich KL, Galloway JB. Non-serious infections in patients with rheumatoid arthritis; results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis. Arthritis Rheumatol. 2021 Apr 12 [Epub ahead of print]. doi: 10.1002/art.41754. PMID: 33844458.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: