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Risk of rheumatoid arthritis in patients with hepatitis C virus infection receiving interferon-based therapy: a retrospective cohort study using the Taiwanese national claims database
  1. Chien-Hsueh Tung1,2,
  2. Ning-Sheng Lai1,2,
  3. Chung-Yi Li3,4,
  4. Shiang-Jiun Tsai5,
  5. Yen-Chun Chen6,
  6. Yi-Chun Chen2,7
  1. 1 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
  2. 2 School of Medicine, Tzu Chi University, Hualien, Taiwan
  3. 3 Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  4. 4 Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
  5. 5 Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
  6. 6 Division of Hepato-Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
  7. 7 Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
  1. Correspondence to Dr Yi-Chun Chen; chenyichun0320{at}


Objectives To illuminate the association between interferon-based therapy (IBT) and the risk of rheumatoid arthritis (RA) in patients infected with hepatitis C virus (HCV).

Design, setting, participants and interventions This retrospective cohort study used Taiwan’s Longitudinal Health Insurance Database 2005 that included 18 971 patients with HCV infection between 1 January 1997 and 31 December 2012. We identified 1966 patients with HCV infection who received IBT (treated cohort) and used 1:4 propensity score-matching to select 7864 counterpart controls who did not receive IBT (untreated cohort).

Outcome measures All study participants were followed until the end of 2012 to calculate the incidence rate and risk of incident RA.

Results During the study period, 305 RA events (3.1%) occurred. The incidence rate of RA was significantly lower in the treated cohort than the untreated cohort (4.0 compared with 5.5 per 1000 person-years, p<0.018), and the adjusted HR remained significant at 0.63 (95% CI 0.43 to 0.94, p=0.023) in a Cox proportional hazards regression model. Multivariate stratified analyses revealed that the attenuation in RA risk was greater in men (0.35; 0.15 to 0.81, p=0.014) and men<60 years (0.29; 0.09 to 0.93, p=0.036).

Conclusions This study demonstrates that IBT may reduce the risk of RA and contributes to growing evidence that HCV infection may lead to development of RA.

  • HCV infection
  • interferon-based therapy
  • rheumatoid arthritis
  • cohort study

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  • Contributors Study design: C-HT, N-SL and Yi-CC. Acquisition of data: Yi-CC and S-JT. Analysis and interpretation of data: C-HT, N-SL, C-YL, S-JT, Ye-CC and Yi-CC. Manuscript writing: C-HT and Yi-CC. All authors were involved in revising the manuscript for important intellectual content and approved the final revision to be published.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Institution Review Board of the Buddhist Dalin Tzu Chi Hospital (B10501028).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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