Oral steroids increases risk of infection in patients with inflammatory disease

Usage of oral steroid in patients with inflammatory diseases like polymyalgia rheumatica or giant cell arteritis significantly increased the risk of infection and the risk increases with higher doses.

The study was published in the 'CMAJ' (Canadian Medical Association Journal).

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 mean age of patients in the study was 73 years. 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 5 mg of prednisolone.

"In periods with prescribed medication, patients' risk was 50 per cent higher than when it was not prescribed," wrote Dr Mar Pujades-Rodriguez, Leeds Institute of Data Analytics, University of Leeds.

"Increases in risk ranged from 48 per cent for fungal to 70 per cent for bacterial infections," added Dr Pujades-Rodriguez.

More than half of patients (22 234, 56 per cent) had infections with the most common infections being lower respiratory tract infections (27 per cent), conjunctivitis (9 per cent) and shingles (7 per cent). More than one-quarter (27 per cent) of patients were admitted to hospital and seven per cent 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 the history of chronic infection (e.g. herpes zoster)," wrote the authors.

The authors suggested that estimates of dose-response (i.e., 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.