title: [Infections of the musculoskeletal system with chronic polyarthritis during a combination therapy with Methotrexate and Leflunomide].
abstract: OBJECTIVE
  The long-term results of rheumatoid arthritis are unsatisfactory despite the mono or combination therapy of conventional "disease-modifying antirheumatic drugs". Therefore in the recent past the administration of a combination of Methotrexate with Leflunomide takes place more frequently. To what extent the perioperative infection rate is influenced by the individual immune-modulating drugs, is still disputed and should quantified on the basis the rheumatism orthopaedic patient collective of an orthopaedic university clinic.
  
  
  METHODS
  The clinical progresses of patients after operative treatment in the orthopaedic hospital, since introduction of the Leflunomide, were evaluated with regard to perioperative infection.
  
  
  RESULTS
  Of 16 patients, who were observed during a period of 1,5 years under a combination therapy by MTX/Leflunomide, three exhibited a heavy infection of the musculoskeletal system.
  
  
  CONCLUSIONS
  The combination of the two above mentioned drugs affects different pathophysiological processes. Synergistic effects in therapy but also with regard to side effects must be expected. First available reports on this combination therapy do not refer to a increased infection/risk. The observation of three serious infections under the combination MTX/Leflunomide prompted us to call attention to this risk. In particular with infection-susceptible bone-surgical operations such a combination of immune-modulating medicines should be employed with caution. The recent literature is discussed.
authors.affiliation: Orthopädische Universitätsklinik Köln, Germany. Karl-Stefan.Delank@medizin.uni-koeln.de
authors.forename: K S
authors.initials: KS
authors.lastname: Delank
authors.forename: T
authors.initials: T
authors.lastname: Hansen
authors.forename: P
authors.initials: P
authors.lastname: Eysel
authors.forename: A
authors.initials: A
authors.lastname: Eckardt
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000209:etiology* / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D019645:Arthroplasty, Replacement, Knee; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects* / Q000627:therapeutic use; D000077339:Leflunomide; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012306:Risk; D018805:Sepsis / Q000209:etiology; D013203:Staphylococcal Infections / Q000209:etiology* / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology* / Q000601:surgery
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide; D008727:Methotrexate