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Chronic osteomyelitis as a risk factor for development of rheumatoid arthritis: a nationwide, population-based, cohort study

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Abstract

An association between occult infection and the development of rheumatoid arthritis (RA) has been suggested. This study aimed to determine if patients with chronic osteomyelitis (COM) are at increased risk of developing RA. A national insurance claim dataset of 22 million enrollees in Taiwan was used to identify 21,105 hospital inpatients with COM and 84,420 reference subjects matched by sex, age, and index date of diagnosis with a mean of 5.12 years of follow-up from 2000 to 2011. The risk of RA development was analyzed using Cox proportional hazards modeling. The mean age of hospital inpatients with COM was 55.8 ± 19.4 years. The incidence of RA was 5.43 per 104 person-years in the case cohort, which was more than twofold higher than that of 2.20 per 104 person-years in the reference cohort. After adjustment, the hazard ratio (HR) was 2.21 (95 % confidence interval, 1.51–3.24). The HR was greatest in the youngest age group (<45 years, HR [95 % confidence interval] = 9.08 [3.22–25.6]; 45–64 years, 1.76 [1.01–3.06]; ≥65 years, 1.68 [0.88–3.24]). In addition, HR was greatest in inpatients with more severe COM (HR [95 % confidence interval] = 0.72 [0.40–1.30] and 11.2 [6.63–18.9] for patients with ≤1 or >2 hospitalization due to recurrent osteomyelitis every two follow-up years, respectively). This is the first report linking COM to risk of incident RA. Patients of a younger age and with frequently recurrent COM had a greater increase in RA risk.

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Acknowledgements

The authors thank the National Health Research Institute in Taiwan for providing insurance claims data for analyses.

Financial support

This work was supported by the grants from the Department of Health, Executive Yuan, Taiwan (Grant DOH 97-HP-1101, 2008, Grant NSC97-2314-B-039-010-MY3, Grant NSC100-2314-B-039-012, Grant NSC101-2314-B-039-020, Grant MOST103-2314-B-039-020), China Medical University Hospital (Grant 1MS1, Grant DMR-97-059, Grant DMR-101-010, and Grant DMR-102-012), Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (Grant MOHW104-TDU-B-212-113002), Academia Sinica Taiwan Biobank, Stroke Biosignature Project (Grant BM104010092), NRPB Stroke Clinical Trial Consortium (MOST 103-2325-B-039 -006), Tseng-Lien Lin Foundation, Taichung, Taiwan, Taiwan Brain Disease Foundation, Taipei, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Fund.

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Authors and Affiliations

  1. Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

    Mao-Wang Ho

  2. Department of Neurology, China Medical University Hospital, Taichung, Taiwan

    Chun-Hung Tseng & Chung-Yi Hsu

  3. School of Medicine, China Medical University, Taichung, Taiwan

    Chun-Hung Tseng, Jiunn-Horng Chen, Joung-Liang Lan & Chih-Hsin Muo

  4. Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

    Jiunn-Horng Chen, Joung-Liang Lan & Chien-Chung Huang

  5. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Chih-Hsin Muo

  6. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan

    Chung-Yi Hsu

  7. Institute of Microbiology and Immunology, Chung-Shan Medical University, Taichung, Taiwan

    Gregory J. Tsay

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  1. Mao-Wang Ho
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  2. Chun-Hung Tseng
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Correspondence to Jiunn-Horng Chen.

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Ho, MW., Tseng, CH., Chen, JH. et al. Chronic osteomyelitis as a risk factor for development of rheumatoid arthritis: a nationwide, population-based, cohort study. Clin Rheumatol 34, 1521–1527 (2015). https://doi.org/10.1007/s10067-015-3020-0

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  • DOI: https://doi.org/10.1007/s10067-015-3020-0

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