Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs

Shigeki Momohara, Kosei Kawakami, Takuji Iwamoto, Koichiro Yano, Yu Sakuma, Ryo Hiroshima, Hitoshi Imamura, Ikuko Masuda, Asami Tokita, Katsunori Ikari

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Abstract

The aim of this study was to identify risk factors for acute surgical-site infection (SSI) after total joint arthroplasty in rheumatoid arthritis (RA) patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs). We performed a retrospective study of all consecutive total hip (THA) and total knee (TKA) arthroplasties performed during a 5-year period (THA 81; TKA 339). Multivariate logistic regression analysis was performed to identify SSI risk factors. Of the patients undergoing THA or TKA, 24 cases (5.7%) developed a superficial incisional SSI requiring the use of antibiotics and three cases (0.7%) developed an organ/space SSI necessitating surgical treatment to remove the artificial joint prosthesis. Multivariate logistic regression analysis revealed that the use of biologic DMARDs [P = 0.0007, odds ratio (OR) = 5.69; 95% confidence interval (CI) 2.07-15.61] and longer RA duration (P = 0.0003, OR = 1.09; 95% CI 1.04-1.14) were the only significant risk factors for acute SSI. Furthermore, an analysis that individually evaluated major agents (n>10) adjusted for disease duration indicated that tumor necrosis factor alpha blockers increased the risk of SSI (infliximab P = 0.001, OR = 9.80, 95% CI 2.41-39.82; etanercept P = 0.0003, OR = 9.16, 95% CI 2.77-30.25). We found that the use of infliximab or etanercept and longer disease duration were associated with an increased risk of acute SSI in RA patients. Prospective studies are thus needed to determine the safety of biologic DMARDs in the perioperative period.

Original languageEnglish
Pages (from-to)469-475
Number of pages7
JournalModern Rheumatology
Volume21
Issue number5
DOIs
Publication statusPublished - 2011 Oct
Externally publishedYes

Fingerprint

Surgical Wound Infection
Knee Replacement Arthroplasties
Antirheumatic Agents
Hip
Rheumatoid Arthritis
Joints
Tacrine
Infection
Odds Ratio
Confidence Intervals
Logistic Models
Regression Analysis
Joint Prosthesis
Perioperative Period
Arthroplasty
Retrospective Studies
Tumor Necrosis Factor-alpha
Prospective Studies
Anti-Bacterial Agents
Safety

Keywords

  • Disease-modifying antirheumatic drugs (DMARDs)
  • Rheumatoid arthritis
  • Surgical-site infection (SSI)
  • Total joint arthroplasty surgery
  • Tumor necrosis factor (TNF) blockers

ASJC Scopus subject areas

  • Rheumatology

Cite this

Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. / Momohara, Shigeki; Kawakami, Kosei; Iwamoto, Takuji; Yano, Koichiro; Sakuma, Yu; Hiroshima, Ryo; Imamura, Hitoshi; Masuda, Ikuko; Tokita, Asami; Ikari, Katsunori.

In: Modern Rheumatology, Vol. 21, No. 5, 10.2011, p. 469-475.

Research output: Contribution to journalArticle

Momohara, Shigeki ; Kawakami, Kosei ; Iwamoto, Takuji ; Yano, Koichiro ; Sakuma, Yu ; Hiroshima, Ryo ; Imamura, Hitoshi ; Masuda, Ikuko ; Tokita, Asami ; Ikari, Katsunori. / Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. In: Modern Rheumatology. 2011 ; Vol. 21, No. 5. pp. 469-475.
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abstract = "The aim of this study was to identify risk factors for acute surgical-site infection (SSI) after total joint arthroplasty in rheumatoid arthritis (RA) patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs). We performed a retrospective study of all consecutive total hip (THA) and total knee (TKA) arthroplasties performed during a 5-year period (THA 81; TKA 339). Multivariate logistic regression analysis was performed to identify SSI risk factors. Of the patients undergoing THA or TKA, 24 cases (5.7{\%}) developed a superficial incisional SSI requiring the use of antibiotics and three cases (0.7{\%}) developed an organ/space SSI necessitating surgical treatment to remove the artificial joint prosthesis. Multivariate logistic regression analysis revealed that the use of biologic DMARDs [P = 0.0007, odds ratio (OR) = 5.69; 95{\%} confidence interval (CI) 2.07-15.61] and longer RA duration (P = 0.0003, OR = 1.09; 95{\%} CI 1.04-1.14) were the only significant risk factors for acute SSI. Furthermore, an analysis that individually evaluated major agents (n>10) adjusted for disease duration indicated that tumor necrosis factor alpha blockers increased the risk of SSI (infliximab P = 0.001, OR = 9.80, 95{\%} CI 2.41-39.82; etanercept P = 0.0003, OR = 9.16, 95{\%} CI 2.77-30.25). We found that the use of infliximab or etanercept and longer disease duration were associated with an increased risk of acute SSI in RA patients. Prospective studies are thus needed to determine the safety of biologic DMARDs in the perioperative period.",
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AU - Iwamoto, Takuji

AU - Yano, Koichiro

AU - Sakuma, Yu

AU - Hiroshima, Ryo

AU - Imamura, Hitoshi

AU - Masuda, Ikuko

AU - Tokita, Asami

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