ORIGINAL ARTICLE Urinary tract infections in patients with rheumatoid arthritis D. Puntis & S. Malik & V. Saravanan & M. Rynne & C. Heycock & J. Hamilton & C. A. Kelly Received: 27 April 2012 / Revised: 11 October 2012 / Accepted: 19 November 2012 / Published online: 14 December 2012 # Clinical Rheumatology 2012 Abstract Co-morbidity from rheumatoid arthritis (RA) has recently focussed on outcomes of cardiovascular and pul- monary disease, but serious infections are an increasingly well-recognised complication of RA. Recent work has dem- onstrated how the incidence of pneumonia can be reduced in RA, but little attention has been paid to the incidence of urinary tract infection (UTI) in RA or to the associated co- morbidity. The aim of this study was to describe the inci- dence of UTI leading to hospitalisation in a large cohort of patients with RA and investigate which factors contributed to this. This study assessed all patients with RA hospitalised over a 12-month period with a discharge diagnosis including UTI. Patients were identified through a PAS records search in a single large centre. Historical case controls without RA matched for age and gender were identified from the litera- ture. Clinical notes were manually examined by two observ- ers. We recorded: age, gender, duration of RA, number of UTI, all RA therapy, co-morbidity, results of urine and blood cultures with antimicrobial sensitivities, readmission rates, treatment and outcome. We calculated the relative risk (RR) of developing UTI in patients with RA and the factors influencing this. From a population of 2,200 RA patients, the overall annual incidence of hospitalisation with UTI amongst RA patients was 2.09 %, as against 0.97 and 0.91 % for two control groups (RR 0 2.16 and 2.29). Most patients (90 %) were female, and the group mean age was 76 years. The use of long-term oral steroids as sole therapy was associated with a RR of 6.8 for UTI (p 0 0.002) while failure to take disease-modifying anti-rheumatic drugs (DMARDs) was associated with a similar RR of 6.7 (p 0 0.001). Positive cultures for Escherichia coli were found in 51 % of RA patients. Relevant co-morbidities included permanent catheters, vaginal prolapse, cancer and diabetes. Recurrence of UTI within a year was common. RA was associated with a higher-than-expected incidence of UTI, particularly among older females. This was associated with the use of long-term oral steroids and the absence of DMARDs. Other factors included female gender, greater age and long disease duration. We recommend avoidance of long-term oral steroids but consideration of low-dose prophylactic antibiotics in those patients with recurrent UTI. Keywords Co-morbidity . Infection . Rheumatoid arthritis Introduction Rheumatoid arthritis (RA) shortens life expectancy [1] for a variety of reasons. Excess deaths occur in part due to infec- tion [2, 3], much of which has been reported as respiratory in origin [4, 5]. Morbidity from sepsis is also common, and a prevalence as high as 45 % over 10 years has been recorded [6, 7]. An increase in hospitalisation for serious infections among patients with RA has recently been confirmed in a longitudinal cohort [8] where risk factors included the pres- ence of extra-articular manifestations and prior use of oral steroids [9]. Recent published work has demonstrated the ability to significantly reduce the mortality associated with pneumonia in RA by using a combination of evidence-based measures [10]. However, there is an impression that RA patients now appear to be hospitalised as a result of urinary tract infections (UTI) as commonly as from pneumonia. This complication of RA has attracted very little attention recently, although an D. Puntis : S. Malik : V. Saravanan : M. Rynne : C. Heycock : J. Hamilton : C. A. Kelly (*) Department of Rheumatology, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK NE96SX e-mail: clive.kelly@ghnt.nhs.uk D. Puntis : S. Malik : V. Saravanan : M. Rynne : C. Heycock : J. Hamilton : C. A. Kelly Department of Medicine, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK NE96SX Clin Rheumatol (2013) 32:355–360 DOI 10.1007/s10067-012-2129-7