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Laryngoscope. 2019 Sep 9. doi: 10.1002/lary.28272. [Epub ahead of print]

Real-world evidence for increased deep neck infection risk in patients with rheumatoid arthritis.

Chang GH1,2,3, Ding MC1, Chen YC4, Yang YH5,6, Liu CY2, Chang PJ7,3, Lee CP2, Lin MH2, Hsu CM1,6, Wu CY1,5,6, Lin KM8,9, Tsai MS1,2,3.

Author information

1
Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
2
Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.
3
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
4
Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
5
Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
6
The School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
7
Department of Nephrology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
8
Division of Rheumatology, Allergy and Immunology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
9
College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Abstract

OBJECTIVE:

To investigate the association between rheumatoid arthritis (RA) and deep neck infection (DNI).

STUDY DESIGN:

Retrospective cohort study.

METHODS:

Patients newly diagnosed with RA between 2000 and 2011 were identified from the National Health Insurance Research Database in Taiwan. Moreover, patients without RA were randomly selected and matched at a 1:4 ratio by age, sex, urbanization level, income, and diabetes mellitus. The patients were followed up until death or the end of the study period (December 31, 2013). The primary outcome was the occurrence of DNI.

RESULTS:

In total, 30,207 patients with RA and 120,828 matched patients without RA were enrolled. Patients with RA had a significantly higher cumulative incidence of DNI than those without RA (P < 0.001). The adjusted Cox proportional hazard model demonstrated that RA was significantly associated with a higher incidence of DNI (hazard ratio: 2.80, 95% confidence interval: 2.26-3.46, P < 0.001). Therapeutic methods (surgical or nonsurgical) did not differ significantly between the patients with RA-DNI and with non-RA-DNI. Patients with RA-DNI had higher rates of tracheostomy, mediastinitis, mediastinitis-related mortality, and mortality than patients with non-RA-DNI, although these differences were without statistical significance. RA patients receiving no therapy experienced higher rates of DNI compared with those receiving methotrexate alone, disease-modifying antirheumatic drugs, or biologic therapies.

CONCLUSION:

This study is the first to investigate the association between RA and DNI. We conclude RA is an independent predisposing factor for DNI.

LEVEL OF EVIDENCE:

4 Laryngoscope, 2019.

KEYWORDS:

Abscess; autoimmune diseases; cellulitis; population-based study; predisposing factor

PMID:
31498447
DOI:
10.1002/lary.28272

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