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Is There an Increased Risk of Infection From RA?

Since being diagnosed with RA, I’ve dealt with a variety of infections. Besides the usual viral, upper respiratory infections, there have been a few bacterial infections. The first was a urinary tract infection (UTI) that is not very common in men. A dose of antibiotics took care of it in rapid form. A few years’ later, chronic sinus infections were the plague of the day. After culturing bacteria from samples, many months of multiple antibiotic treatments were in order. When that failed to take care of the infection, sinus surgery finally cleared up the issue. The most recent infectious ordeal was a battle with bacterial meningitis. Two trips to the emergency room and admission for an overnight stay in the hospital were the result of this recent escapade. It culminated in the installation of a peripherally inserted central catheter or PICC line (see photo)
andrew lumpeso I could self-infuse a strong antibiotic. This infection didn’t just come from the blue but was likely connected to a lumbar puncture conducted for injecting iodine contrast for a CT scan of my neck. The fact that I’m immunocompromised from taking the biologic Rituxan (Kelesidis et al., 2011)1 caused the doctors to take an aggressive approach in treating the meningitis even though it was considered a “mild” case. One doctor compared me to an “immunocompetent” person who is able to better fight off an infection.

In a study predicting infections in RA patients, it was found that 64% had at least one infection and almost 50% had an infection requiring hospitalization (Doran, et al., 2002).2 These are large proportions of RA patients who fight infections. This represents an important issue for those of us who suffer with RA.

There seems to be four factors that are connected to increased risk of infections in RA patients – 1. The disease itself, 2. Comorbid conditions, 3. Lifestyle behaviors, and 4. Treatments for the RA (Listing & Zink, 2013; Crowson, et al, 2012).3, 4

The immune system begins to fail as a person gets older. For example, such impact of aging on the immune system is in seen in the increased proportion of cases of shingles in elderly populations (Arvin, 2005).5 In RA patients this immune system aging is accelerated and is linked to the instability of DNA leading to a loss of T cell lymphocytes that are a critical part of the immune system (Weyand, 2010).6

There is an increased risk of infection if an RA patient suffers with comorbid conditions (simultaneous chronic conditions) and extra-articular (outside the joint) symptoms which may include coronary heart disease, heart failure, peripheral vascular disease, chronic lung disease, diabetes, and alcoholism (Crowson, et al., 2012).7 Lifestyle choices including smoking also increase infection risk in RA patients (Listing & Zink, 2013).8

Many RA treatments suppress the immune system increasing risk of infection. The disease-modifying (DMARD) set of drugs, including the most popular methotrexate, are thought to suppress the immune system theoretically leading to an increased rate of infection. However, a recent study demonstrated that DMARDs did not really increase this risk (Germano, et al., 2014).9 Researchers demonstrated that biologic treatments are commonly associated with an increased risk of infection (Walsh, 2014)10 and most of these drugs include side effect warnings to this effect. But this increased risk may be overstated, as the risk may be small (Galloway, et al., 2010).11 Many doctors don’t recommend long-term use of corticosteroids and one of the reasons is a negative impact on the immune system along with an increase in infections (Russell, 2013).12

I don’t believe that living with RA means we always need to look over our shoulders for infections. However, given the potential reasons for increased infection risk, it is important that RA patients make some informed decisions. Avoiding people who are actively contagious is wise counsel. But we still need to live and that involves being around others – a life without relationship is not a healthy one. Get all possible vaccines and avoid vaccines that contain live viruses. If you have comorbid conditions or extra-articular symptoms, you should be extra keen about avoiding infections. If you smoke, try to quit as it only compounds the risk of infection. If you get an infection, speak with your doctor about whether or not to stop your RA treatment until the infection is under control. Finally, make treatment decisions with your doctors that include costs and benefits. For many patients, the risk of an infection is less than the impact of the disease and this necessitates aggressively treating the disease and hoping that infections don’t get in the way.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  5. Arvin A. Aging, immunity, and the varicella-zoster virus. N Engl J Med. 2005 Jun 2;352(22):2266–2267.


  • Patricia
    5 years ago

    I am not having to have infusions or any of that type stuff (so far, thank God!), but take 7 Methotrexate pills one day per week, take 2 Hydroxycholoquine pills every day, plus take Folic Acid, which my rheumatologist says is a must for Methotrexate users. My rheum. doesn’t believe in overdoing the Predizone thing, so I was only on a full dose of that for 6 weeks and 1/2 a dose of it for about 8 weeks…Then never again with that. It was only a “band aid” until my DMDs had a chance to kick in. When I was first diagnosed with RA, my inflammation level was “off the charts”…my body was overloaded with inflammation…not any more, thank God!! Before beginning RA drugs, I was constantly having some infection; UTIs, sinus infections, ear infections, etc etc…Now (knock on wood) since the inflammation is under control, I’m not having all that stuff any more. I’m in clinical remission, and feel super lucky! Also very thankful for a very good rheumatologist!!!

  • Darla
    5 years ago

    Hi Andrew, hope you are feeling better. Since my diagnosis of RA in 2008, I
    have had many infections. Just finished a 20 day prescription of antibiotics
    for UTI and sinus. Cipro first, then Cefpodoxime. I take probiotics several times a day, vitamin C, drink lots of water. Still have occasional eye infections,
    odd cysts, many skin rashes, bruising, things I never had. On Remicade and
    Placquenil after years of Metatrexate and Predizone. Muscle weakness. Maybe one day they will find a cure. Blessings to you.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Darla, I cure would be nice! I’m feeling better now. Thanks. Be careful with Cipro as it can cause tendon problems which is not good for people with RA.

  • Cassandra Bird
    5 years ago

    Thank you Andrew. Compelling arguments. I was leading up to diagnosis and for months after; besieged by infection after infection, culminating in a hospital stay back in October. I had to come off methotrexate as I appeared to have methotrexate poisoning of the lungs. I’ve been on sulfasalazine since and given up smoking cigarettes,my lungs have healed beyond expectations. I’m about to begin enbrel and have some concerns about my immune system taking a dive again. This disease has hit me hard and fast and as you say the disease of RA itself and the damaging it is causing to my body, makes the risk worthwhile. I pray this works. I pray for even some small resemblance of the person I once was. I hope you are as well as you can be, thank you again for the writing 🙂

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Yes, there are trade-offs. Glad you stopped smoking as that will help. Hope Enbrel works well for you. Glad you liked the article.

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