Rheumatoid arthritis is the major risk factor for septic arthritis in rheumatological settings
Introduction
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and is associated with increased morbidity and a shortened lifespan. A high frequency of infections complicating RA has been reported during the last 40years. In particular high rates of septic arthritis (SA), a disabling condition that requires prompt diagnosis and treatment and that may cause synovial joint destruction and death, have been described [1], [2]. The finding that up to 40% of patients with SA have RA further support the evidence of the increased risk in patients with RA [3]. This may be due to several reasons: joint disease predisposes to bacterial joint colonization and RA itself and its treatment with corticosteroids, disease-modifying antirheumatic drugs (DMARDs) and biological therapies may decrease the immune function required for protection from bacterial pathogens. Staphylococcus aureus is the bacterium responsible for up to 80% of joint infections in patients with RA [4] and it has been shown that S. aureus and other gram-positive bacteria are potent inducers of TNF-α secretion from macrophages [5] and that a local increase of TNF-α levels might improve host defences against staphylococcal foreign body infections [6]. The aim of our study therefore was to retrospectively evaluate all septic arthritis cases admitted to our Rheumatology Unit in the last 12 years to assess the causative microorganisms and the risk factors, and to look at the underlying rheumatic diseases and the effect of DMARDs on the likelihood of developing SA.
Section snippets
Patients and methods
The medical records of 49 consecutive patients with septic arthritis admitted to our Rheumatology Unit between January 1995 and October 2007 were reviewed. The patients ranged in age from 15 to 90 and they were predominantly men (53.1%). Infections restricted to the spine or to the sacroiliac joint were excluded. Septic arthritis was diagnosed based on the finding of purulent material in the joint space and/or the isolation of a bacterial pathogen from joint fluid. Demographic data, risk
Statistics
The results were analysed using 95% confidence intervals to compare proportion of joint diseases and different therapies. p < 0.05 was considered statistically significant.
Results
Between January 1995 and October 2007, 49 patients with AS were discharged from our Operative Unit of Rheumatology. A predisposing factor was recorded in 91.8% and previous joint disease was evident in 34 patients. RA was commonly seen (32%), compared with its expected frequency in the population (1%). Indeed, RA was the most frequent joint disease compared to all the other arthropathies (p < 0.05). In fact, psoriatic arthritis was observed in 8.1% of cases, undifferentiated seronegative
Discussion
Cytotoxic drugs and corticosteroids are commonly used to treat autoimmune and rheumatic diseases and the control of inflammation and autoimmune mechanisms is at the expense of more or less severe immunosuppression which may lead to infectious complications due to an impaired immune response against infectious agents. The use of immunosuppressive drugs has been suggested as a cause of increased SA [7]. RA patients are twice as likely to develop an objectively confirmed infection compared with
Take-home messages
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Rheumatoid arthritis and immunosuppressive and steroid therapies are relevant risk factors in the development of septic arthritis.
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It is necessary to exclude a superimposed septic arthritis in every patient with rheumatoid and a hot painful joint.
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