Modern rheumatology
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Modern rheumatology · Oct 2011
Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs.
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. ⋯ 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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Modern rheumatology · Oct 2011
Case ReportsSuccessful treatment of a patient with IgG4-related disease with a paravertebral mass lesion.
A 68-year-old woman was admitted with bleary eyes and lacrimal gland swelling. A biopsy specimen from a right paravertebral mass lesion detected by computed tomography showed remarkable IgG4-positive plasma cells. ⋯ Administration of 30 mg of oral prednisolone effectively reduced the lacrimal gland swelling and paravertebral mass volume. Nine months after the initiation of prednisolone, serum IgG4 was reduced to 31.4 mg/dl, and there was norecurrence.