RT Journal Article
SR Electronic
T1 Infection rates before and after a diagnosis of IgA vasculitis in childhood: a population-wide study using non-exposed matched controls.
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.190110
DO 10.3899/jrheum.190110
A1 Johannes Nossent
A1 Warren Raymond
A1 Helen Keen
A1 David B.  Preen
A1 Charles A  Inderjeeth
YR 2019
UL http://www.jrheum.org/content/early/2019/06/11/jrheum.190110.abstract
AB Objective Clinical data suggests that infections can trigger IgA vasculitis (IgAV), but longterm observations are lacking. We compared rates, types and microorganisms for serious infection (SI) before and after diagnosis for children with IgAV and non-exposed controls. Methods Using population-based administrative linked health datasets we estimated incidence rates (IR) for SI per 1,000 person-months for IgAV patients (n=504, age 5 years, 59.1% males) and controls matched for age, gender and year of presentation (n=1,281, age 6 years, 65% males). Time-zero (T0) was the date of IgAV diagnosis or equivalent date in controls, lookback (median 38 months) the period prior to and follow-up (median 239 months) the period after T0. Results During lookback, SI prevalence was similar in IgAV patients and controls (11.5 vs 9.5%), but IgAV patients had a higher rate of upper respiratory infections (URTI) [incidence rate ratio (IRR) 1.79; 95% CI 1.39-2.31)] with shorter time between first SI and T0 (27 vs 43 months, p=0.02). During follow-up, IgAV patients were at a constant increased risk for SI (IRR 1.46, 95% CI 1. 35-1.58). Especially rates for sepsis (IRR 12.6), pneumonia (IRR 6.19), URTI (IRR 2.36) and skin infections (IRR 1.85) were higher during follow-up. There was little overlap between patients with SI in lookback and follow-up. Conclusion In IgAV childhood patients there is an increased long-term risk for a broader spectrum of infections, which is unrelated to SI prior to diagnosis or treatment. This suggests disease specific factors may have a lasting effect on immune-competence in childhood IgAV.