Patients using oral steroids that have the inflammatory disease polymyalgia rheumatica and/or giant cell arteritis have a significantly increased chance of infection.
A study in CMAJ (Canadian Medical Association Journal), found that patients taking oral steroids when they have an inflammatory disease such as polymyalgia rheumatica and/or giant cell arteritis could increase the risk of infection, and moreover this risk increased with higher doses.
The risk of taking oral steroids
In a large study of almost 40,000 adult patients with polymyalgia rheumatica or giant cell arteritis in England, researchers found higher absolute risks of infection when patients were taking oral steroids than when they were not taking them.
The steroids included prednisolone, prednisone, hydrocortisone and cortisone. The risk of infection increased with higher doses and was elevated even with low daily doses of less than 5mg of prednisolone.
Dr. Mar Pujades-Rodriguez, Leeds Institute of Data Analytics, University of Leeds, UK, wrote: ‘In periods with prescribed medication, patients’ risk was 50% higher than when it was not prescribed.’
‘Increases in risk ranged from 48% for fungal to 70% for bacterial infections.’
Details of the study
The average age of patients in the study was 73 years, with more than half of patients (22,234, 56%) had infections, with the most common infections being;
- Lower respiratory tract infections (27%); and
- Conjunctivitis (9%) and shingles (7%).
27% of patients were admitted to hospital and 7% died within a week of diagnosis of infection.
‘Patients and clinicians should be educated about the risk of infection, need for symptom identification, prompt treatment, timely vaccination and documentation of history of chronic infection (e.g. herpes zoster),’ wrote the authors.
They suggest that estimates of dose-response, such as the magnitude of risk related to steroid dosing, can be useful for policy makers in assessing new glucocorticoid-sparing drugs for patients with these inflammatory diseases.
