The long preclinical phase of rheumatoid arthritis (RA), where some factors involved in RA pathogenesis circulate peripherally, raises concern of RA transmissibility through blood transfusion. Specifically, this possibility is suggested by murine RA models in which anticitrullinated peptide/protein antibodies may induce and enhance arthritis, and precursors of the RA-fibroblast-like synoviocyte cells may aggravate and spread the disease between joints.
We used a large Danish–Swedish Health register information on 1.5 million blood donors and 2.1 million recipients of their blood. The aim of this study was: (1) RA occurrence in recipients of blood from donors who later developed RA and (2) clustering of RA among recipients of blood from individual donors, regardless of the donor’s RA status. We used two different approaches to analyse RA transmission.
Among a total of 938 942 blood donors, 2412 were diagnosed with RA during follow-up. We identified 13 369 patients (exposed) who received at least one unit from donors with later RA and 139 470 patients (unexposed) who received blood units from the matched donors who were free of RA at selection. Recipient RA risk did not vary by donor RA occurrence, whether overall, by RA serotype, donor age at RA diagnosis or interval between donation and donor RA diagnosis.
Similarly, recipient RA risk did not also vary by RA occurrence in previous recipients of blood from the same donor, neither for all types of RA combined (HR per previous recipient with RA, 0.96; 95% CI 0.86 to 1.07) nor for specific RA subtypes.
In conclusion, we found no evidence that RA or RA risk is transmitted through blood transfusion. In light of the study’s strengths, including low likelihood of confounding and large study size ensuring meaningful statistical power, we believe the possibility of RA transmission is unlikely to be clinically relevant.
Ann Reum Dis 2018, Mar 1 [Epub ahead of print]
Transmission of rheumatoid arthritis through blood transfusion: a retrospective cohort study
Just SA, Rostgaard K, Titlestad K, Edgren G, Erikstrup C, Ullum H, Pedersen OB, Nielsen KR, Askling J, Lindegaard H, Hjalgrim H.