Effect of different DMARD use on the frequency of urinary infection in patients with rheumatoid arthritis

Abstract

Aims: It is known that the susceptibility to infection in general is increased in Rheumatoid Arthritis (RA) patients, but there is not enough information about whether urinary tract infections in particular differ according to different disease-modifying antirheumatic drugs (DMARDs) groups. The aim of this study was to compare the frequency of urinary infection attacks and pathogens in urine cultures of patients with RA treated with different groups of DMARDs. Methods: In this retrospective study, 76 patients using biologic DMARDs (bDMARDs) and 74 patients using conventional synthetic DMARDs (csDMARDs) among patients followed with a diagnosis of RA for at least 5 years who came for regular follow-ups at our department’s rheumatic diseases outpatient clinic were included. Patients with known immunodeficiency conditions, use of prednisolone (>7.5 mg), chronic renal failure, and renal pathologies were excluded from the study. The evaluation and follow-up records of the included patients between 01.01.2019 and 31.12.2022 were examined. Patients age, sex, medications, comorbidities, urine biochemistry, and urine culture results were recorded. Patients with pyuria detected by urine biochemistry were considered to have a urinary infection. Results: The mean age of patients in the csDMARD group was 61.39±11.41 (37-87) and the mean age of patients in the bDMARD group was 58.68±11.42 (33-89) (p=0.149). The number of urinary infection attacks during the follow-up period was similar in both the groups (p =0.090). The positive culture rate was 23.21% in the bDMARD group and 7.5% in the csDMARD group (p = 0.072). Escherichia coli was detected in 81.8% and Pseudomonas aeruginosa was detected in 18.2% of the positive cultures in the bDMARD group. The pathogen in all positive cultures of the csDMARD group was Escherichia coli. Conclusion: Although urinary infection and positive culture rates were higher in patients receiving bDMARDs, no statistically significant difference was observed between the groups.