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Incidence, risk factors and validation of the RABBIT score for serious infections in a cohort of 1557 patients with rheumatoid arthritis


Rheumatology (Oxford). 2020 Dec 9;keaa557. doi: 10.1093/rheumatology/keaa557.Online ahead of print.

Konstantinos Thomas, Argyro Lazarini 1, Evripidis Kaltsonoudis 2, Paraskevi V Voulgari 2, Alexandros A Drosos 2, Argyro Repa 3, Ainour Molla Ismail Sali 3, Prodromos Sidiropoulos 3, Panagiota Tsatsani 4, Sousana Gazi 4, Argyriou Evangelia 5, Kyriaki A Boki 5, Pelagia Katsimbri 1, Dimitrios Boumpas 1, Kalliopi Fragkiadaki 1, Maria G Tektonidou 1, Petros P Sfikakis 1, Konstantina Karagianni 6, Lazaros I Sakkas 6, Eleftheria P Grika 1, Panagiotis G Vlachoyiannopoulos 1, Gerasimos Evangelatos 7, Alexios Iliopoulos 7, Theodoros Dimitroulas 8, Alexandros Garyfallos 8, Konstantinos Melissaropoulos 9, Panagiotis Georgiou 9, Maria Areti 10, Constantinos Georganas 11, Periklis Vounotrypidis 12, Georgios Georgiopoulos 1, George D Kitas 1 13, Dimitrios Vassilopoulos 1

Author Information

1 Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.

2 Rheumatology Clinic, University of Ioannina, Ioannina, Greece.

3 Clinical Immunology and Allergy Department, University of Crete, Heraklion, Greece.

4 Rheumatology Unit, KAT Hospital, Athens, Greece.

5 Rheumatology Unit, Sismanoglio Hospital, Athens, Greece.

6 Department of Rheumatology, University of Thessaly, Larissa, Greece.

7 Rheumatology Unit, NIMTS Hospital, Athens, Greece.

8 4th Department of Medicine, Aristotle University, Thessaloniki, Greece.

9 Rheumatology Unit, Agios Andreas Hospital, Patras, Greece.

10 Private Practice, Leivadia, Greece.

11 Private Practice, Athens, Greece.

12 Private Practice, Thessaloniki, Greece.

13 Rheumatology Department, Hygeia Hospital, Athens, Greece.


Objectives: Predicting serious infections (SI) in patients with rheumatoid arthritis (RA) is crucial for the implementation of appropriate preventive measures. Here we aimed to identify risk factors for SI and to validate the RA Observation of Biologic Therapy (RABBIT) risk score in real-life settings.

Methods: A multi-centre, prospective, RA cohort study in Greece. Demographics, disease characteristics, treatments and comorbidities were documented at first evaluation and one year later. The incidence of SI was recorded and compared with the expected SI rate using the RABBIT risk score.

Results: A total of 1557 RA patients were included. During follow-up, 38 SI were recorded [incidence rate ratio (IRR): 2.3/100 patient-years]. Patients who developed SI had longer disease duration, higher HAQ at first evaluation and were more likely to have a history of previous SI, chronic lung disease, cardiovascular disease and chronic kidney disease. By multivariate analysis, longer disease duration (IRR: 1.05; 95% CI: 1.005, 1.1), history of previous SI (IRR: 4.15; 95% CI: 1.7, 10.1), diabetes (IRR: 2.55; 95% CI: 1.06, 6.14), chronic lung disease (IRR: 3.14; 95% CI: 1.35, 7.27) and daily prednisolone dose ≥10 mg (IRR: 4.77; 95% CI: 1.47, 15.5) were independent risk factors for SI. Using the RABBIT risk score in 1359 patients, the expected SI incidence rate was 1.71/100 patient-years, not different from the observed (1.91/100 patient-years; P = 0.97).

Conclusion: In this large real-life, prospective study of RA patients, the incidence of SI was 2.3/100 patient-years. Longer disease duration, history of previous SI, comorbidities and high glucocorticoid dose were independently associated with SI. The RABBIT score accurately predicted SI in our cohort.