title: Relapsing oligoarticular septic arthritis during etanercept treatment of rheumatoid arthritis.
abstract: Septic arthritis is a commonly reported complication of rheumatoid arthritis (RA). Tumor necrosis factor alpha (TNF-alpha) plays an important role in host defense against infection. Inhibition of its activity could therefore be anticipated to augment the risk of infection. Both opportunistic and bacterial infections have been described in patients with RA treated with anti-TNF-alpha therapy. We describe a patient who experienced 2 episodes of septic arthritis. Both occurred while the patient was on etanercept. Recurrence developed despite prolonged parenteral antibiotic. To our knowledge, this is the first report of relapsing oligoarticular methicillin-sensitive Staphylococcus aureus septic arthritis despite prolonged antibiotic treatment in a patient receiving etanercept therapy. Our case underscores the advisability of discontinuing TNF-alpha blockade in patients with septic arthritis during prolonged antimicrobial therapy.
authors.affiliation: Division of Rheumatology, New York University School of Medicine/Hospital for Joint Diseases, 301 East 17th Street, Rm. 1410, New York, NY 10003, USA. mora01@med.nyu.edu
authors.forename: Adam
authors.initials: A
authors.lastname: Mor
authors.forename: Hal J
authors.initials: HJ
authors.lastname: Mitnick
authors.forename: Jeffry B
authors.initials: JB
authors.lastname: Greene
authors.forename: Natalie
authors.initials: N
authors.lastname: Azar
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Budnah
authors.forename: Joseph
authors.initials: J
authors.lastname: Fetto
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000382:microbiology*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008297:Male; D016106:Methicillin Resistance; D018124:Receptors, Tumor Necrosis Factor / Q000037:antagonists & inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept