[Phlegmon of the forearm due to therapy with Anakinra (interleukin-1 receptor-antagonist)].
BACKGROUND
Biological modifiers (BM) are very effective in a high percentage of patients with rheumatoid arthritis being resistant to disease modifying antirheumatic drugs (DMARD). In the beginning, the therapy with the BMs was thought to be of low risk. However, due to the increase of application, a few lethal septical complications have been reported.


METHODS
A 38 year old male with rheumatoid arthritis and insulin deficiency diabetes mellitus achieved remission under the therapy with Anakinra within three days. Due to a spontaneous disrupture of the finger extensor tendons operative revision was performed. A phlegmon from the dorsum of the hand to the cubita was found five months after resection of a septical cubital bursa.


CONCLUSIONS
The very effective suppression of the immune system by the BMs should not lead to noncritical therapy in patients with history of infections of bone, joints and soft tissue, because inactive organism may start growing and lead to undetected lethal sepsis.
Gaulke
R
R
Evangelische Stiftung Volmarstein Klinik II: Rheumaorthopädie- Endoprothetik, Sektion Handchirurgie, Lothar-Gau-Str. 11, 58300 Wetter-Volmarstein, Germany.
D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000601:surgery; D002481:Cellulitis / Q000139:chemically induced* / Q000175:diagnosis; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis; D004551:Elbow Joint / Q000601:surgery; D005384:Finger Joint / Q000601:surgery; D005500:Follow-Up Studies; D005542:Forearm; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D053590:Interleukin 1 Receptor Antagonist Protein; D008297:Male; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors*; D012086:Reoperation; D012422:Rupture, Spontaneous; D012795:Sialoglycoproteins / Q000009:adverse effects* / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000139:chemically induced* / Q000175:diagnosis; D013710:Tendons / Q000601:surgery*; D014955:Wrist Joint / Q000601:surgery
C507763:IL1RN protein, human; D007155:Immunologic Factors; D053590:Interleukin 1 Receptor Antagonist Protein; D017472:Receptors, Interleukin-1; D012795:Sialoglycoproteins