Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome

Fragoulis, G. E., Paterson, C., Gilmour, A., Derakhshan, M. H., McInnes, I. B. , Porter, D. and Siebert, S. (2018) Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome. RMD Open, 4(2), e000739. (doi:10.1136/rmdopen-2018-000739) (PMID:30402267) (PMCID:PMC6203094)

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Abstract

Objectives To determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management. Methods: The Scottish Early Rheumatoid Arthritis inception cohort prospectively recruited patients with newly diagnosed RA and followed them up every 6 months. Patients with RA who developed at least one episode of neutropaenia (grade 1: <2.0×10^9/L; grade 2: <1.5×10^9/L; grade 3: <1.0×10^9/L; grade 4: <0.5×10^9/L) were compared with those who did not. Comparisons were also made between patients who experienced one or more episodes of neutropaenia and between patients with different neutropaenia grades. Results: 77 neutropaenia episodes were recorded in 58 of 771 (7.5%) patients with RA, who were followed up for a median (range) of 18 (6–48) months. Neutropaenia occurred at a median (range) of 12 (0–120) months after RA diagnosis. The majority had mild neutropaenia (grade 1: n=42; grade 2: n=14; grade 3: n=1; grade 4: n=1). Neutropaenia was transient (single episode) in the majority (44; 75.8%) of cases but led to treatment discontinuation in 14 (24.1%) patients. Patients who developed neutropaenia were more likely to be female (p=0.01) and non-smokers (p=0.007) and had lower baseline neutrophil levels (p<0.0001). Binomial regression analysis confirmed the latter (p<0.0001, B: −0.491) as neutropaenia predictor. The rate of infections did not differ between patients who developed neutropaenia and those who did not (p=0.878). Conclusion: Neutropaenia was a common finding in this cohort. It was usually mild, transient and not associated with increased infection rates. Neutropaenia occurrence was associated with non-smoking, female gender and lower baseline neutrophil levels.

Item Type:Articles
Additional Information:The SERA cohort was supported by joint funding from the Chief Scientist’s Office (award ref ETM-40) and Pfizer.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McInnes, Professor Iain and Gilmour, Miss Ashley and Porter, Dr Duncan and Derakhshan, Dr Mohammad and Siebert, Dr Stefan and Fragoulis, Dr George and Paterson, Miss Caron
Authors: Fragoulis, G. E., Paterson, C., Gilmour, A., Derakhshan, M. H., McInnes, I. B., Porter, D., and Siebert, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:RMD Open
Publisher:BMJ Publishing Group
ISSN:2056-5933
ISSN (Online):2056-5933
Published Online:08 October 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in RMD Open 4(2): e000739
Publisher Policy:Reproduced under a Creative Commons License

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