.A wonderful woman was born in 1945 on a small farm far from the lights of the city. On this farm, hard work was not only necessary but also an ingrained trait that carried with this woman throughout the rest of her life. Despite being diagnosed with Rheumatoid Arthritis [RA] at the young age of 25 this woman continued to work, and raise kids living to the age of 76. However, the disease attacking her joints caused chronic pain, and the medication only gave her terrible side effects. This woman was my Grandmother and her strength and grit she had for life despite her condition, still inspires me today. RA is an autoimmune disease that attacks the joints of the patient and comes with an increased risk of infections due to the prematurely aged immune system, or due to the immunosuppressant treatment for the disease (D. Scott 2010). In comparison to the general population, the mortality risk of infections has increased 2-6x. Furthermore, population-based studies show an increased risk for admission to an intensive care unit (ICU) in patients with RA compared to the general population (with a hazard ratio [HR]: 1.65, 95% confidence interval [CI]: 1.50-1.83). (M. Krasselt, 2020). Overall it was seen that the second most common reason for ICU admission in patients with RA (after ischemic cardiovascular diseases) are infections. this was concluded from the observations collected by Rheumatology, Medical Department III—Endocrinology, Nephrology and Rheumatology, University Hospital of Leipzig, Leipzig, Germany, and the Medical Intensive Care Unit, University Hospital of Leipzig, Leipzig, Germany.
In the most recent study published this year in the Journal of Intensive Care Medicine, there was a retrospective analysis done through the University Hospital of Leipzig. The study looked at RA patients older than 18 admitted into the ICU with sepsis between February 2006 - January 2019, in comparison to non-RA patients admitted sepsis to the ICU within the same time frame (M. Krasselt, 2020). The study analyzed the hospital's epidemiological data and clinical outcome using Sequential Organ Failure Assessment (SOFA) and the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) (M. Krasselt, 2020). Although Septic shock was more often diagnosed among patients with RA, 65.3% versus (non-RA) 29.4%, gave a significant P-value = .0006. In bivariate analysis, septic shock was significantly more frequent in non-surviving patients with RA (P = .001) this was also true for vasopressor use (P = .007). Lastly, the in-hospital mortality was significantly higher in patients with RA than among controls (42.9% vs 15.7%, P = .0016) (M. Krasslet, 2020).
However, as impressive this study outcome is I am disappointed in the sample size in which they chose to use for the analysis. By only using their own data at the university hospital and not reaching out to more hospitals for data to include for their analysis I believe the authors have an error in their experimental planning. Also only analyzing their own school from which the data is collected from this can serve as a conflict of interest as well since the reputation of the institution can be affected as well from the study. There needs to be data from various hospitals in the same time frame because not all hospitals are run the same way and may have differences in their ICU patient procedures, doctors, environments, etc. These are aspects that may change the way RA patients with sepsis or non-RA patients recover and provide further room to question the sepsis mortality. So why is this important to understand? Well, as a future doctor I strive to find the best knowledge to provide my best care and instruction to my future patients based on reputable science.
M. Krasselt, MD, C. Baerwald, MD, Ph.D., S. Petros, MD, Ph.D., and O. Seifert, MD, Ph.D. 2020 Mortality of Sepsis in Patients With Rheumatoid Arthritis: A Single-CenterRetrospective Analysis and Comparison With a Control Group: Journal of Intensive Care Medicine. Published April 6, 2020, https://doi.org/10.1177/0885066620917588
D. Scott, F. Wolfe, T. Huizinga. 2010 Rheumatoid Arthritis: The Lancet. 2010 Sep 25;376(9746):1094-108. DOI: 10.1016/S0140-6736(10)60826-4. PMID: 20870100.
G. Ngian. 2010 Rheumatoid Arthritis: Aust Fam Physician. 2010 Sep;39(9):626-8. PMID: 20877764.
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