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Study links disease duration with infection after TJA in patients with RA
Momohara S. Mod Rheumatol. 2011 Feb 12. [Epub ahead of print]. doi: 10.1007/s10165-011-0423-x.
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This retrospective study conducted by Japanese researchers identifies a longer disease duration and use of biologic disease-modifying antirheumatic drugs as risk factors for acute surgical-site infections in patients with rheumatoid arthritis who undergo total joint arthroplasty.
The researchers studied 81 total hip and 339 total knee arthroplasties performed during a 5-year period in patients with rheumatoid arthritis (RA) who were treated with nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs). The study revealed that 5.7% and 0.7% of patients developed superficial incisional surgical-site infections (SSIs) and organ SSIs, respectively.
The researchers discovered that the use of biologic DMARDs and a longer duration of RA were significant risk factors for developing acute SSIs, according to the study abstract. Further analysis showed that tumor necrosis factor alpha blockers raised the risk of SSIs when the researchers adjusted major agents for disease duration.
“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,” the authors wrote in their abstract. “Prospective studies are thus needed to determine the safety of biologic DMARDs in the perioperative period.”
Patients with rheumatoid arthritis benefit greatly from joint replacement, but have an increased risk of surgical site infection; therefore, information regarding treatment protocols to reduce infection is valuable. Although DMARDs are commonly used in this patient group, there is little definitive data concerning their effect on infection rates and their management in the perioperative period. This study provides useful information on this topic, but further studies are needed in this area.
– David M. Lichtman, MD
Professor and Chairman
Department of Orthopedic Surgery
University of North Texas Health Science Center
John Peter Smith Hospital
Fort Worth, TX
– Russell A. Wagner, MD
Associate Professor and Vice Chairman
Department of Orthopedic Surgery
University of North Texas Health Science Center
Residency Program Director
John Peter Smith Hospital
Fort Worth, Texas
Disclosure: They have no conflicts of interest.