Prosthetic joint infection in patients with rheumatoid arthritis: an outcome analysis compared with controls

• Published in: PloS one Vol. 8; no. 8; p. e71666
• Main Authors: Hsieh, Pang-Hsin, Huang, Kuo-Chin, Shih, Hsin-Nung
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26.08.2013; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Amputation; Analysis of Variance; Anti-Bacterial Agents - therapeutic use; Antibiotics; Arthritis; Arthritis, Rheumatoid - complications; Arthroplasty, Replacement, Knee - statistics & numerical data; Bacteria - classification; Bacteria - drug effects; Bone implants; Cement; Comorbidity; Debridement - methods; Demographics; Exchanging; Failure; Female; Health risk assessment; Hip; Hospitals; Humans; Immunosuppressive agents; Infections; Joint diseases; Joint surgery; Knee; Knee Prosthesis - microbiology; Male; Medicine; Middle Aged; Outcome Assessment (Health Care) - methods; Outcome Assessment (Health Care) - statistics & numerical data; Patients; Prognosis; Prostheses; Prosthesis-Related Infections - complications; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - therapy; Retention; Retrospective Studies; Rheumatoid arthritis; Studies; Surgery; Survival Analysis; Transplants & implants; Tumor necrosis factor-TNF; Viral infections; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0071666

Patients with rheumatoid arthritis (RA) have been shown to have an increased susceptibility to the development of prosthetic joint infection (PJI) after hip or knee replacement. However, little information is available on the demographic data, outcome of treatment and prognostic factors in RA patients when compared to those in non-RA patients. We performed a retrospective cohort analysis of all cases of PJI that were treated at our institution between 2002 and 2008. Of 346 episodes of PJI during the study period, 46 (13.3%) occurred in patients with RA. Compared to the non-RA cohort, RA patients with PJI were female predominant (74% vs 27%, p<0.001), younger (median age, 51 vs 63 years, p<0.001) and developed infection earlier (median joint age, 72 vs 128 days, p<0.001). The 2-year survival rate free of treatment failure was lower in RA patients with PJI episodes either treated with débridement (22% vs 52%, p = 0.002) or two-stage exchange (78% vs 95%, p = 0.004). A longer duration of symptoms before débridement surgery (median, 11 vs 5 days, p = 0.015), and absence of antibiotics in bone cement for two-stage exchange (relative risk, 8.0; p = 0.02) were associated with treatment failure in patients with RA. The outcome of PJI in RA patients was generally worse than that in non-RA patients. Risk of treatment failure increased in the setting of delayed débridement and two-stage exchange without the use of antibiotic-impregnated bone cement. These findings highlight the importance of vigilant monitoring and aggressive treatment for PJI in RA patients.