title: Late infection of total knee arthroplasty inflamed by anti-TNFalpha, Infliximab therapy in rheumatoid arthritis.
abstract: We report a case of sudden onset of late infection after TKA inflamed by anti-TNFalpha therapy, Infliximab, in a 54-year-old woman with RA. Infliximab therapy was started 3 years and 8 months after TKAs as a result of multiple arthritides showing high inflammation of RA. One week after the third administration of Infliximab, the patient suffered sudden knee pain and infectious clinical symptoms, and bacteria (MSSA) were detected by joint effusion culture. She was successfully treated by open debridement with antibiotics-loaded calcium phosphate bone paste and cement and the prostheses were retained. Early diagnosis and operative treatment might be the key to controlling infected TKA without removing the implant. This present case might indicate a serious risk of immunosuppressive effects caused by Infliximab.
authors.affiliation: Department of Orthopaedic Surgery, Osaka Koseinenkin Hospital, Osaka, Japan. takayuru@med.kobe-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Yurube
authors.forename: Koichiro
authors.initials: K
authors.lastname: Takahi
authors.forename: Hajime
authors.initials: H
authors.lastname: Owaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fuji
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
authors.forename: Minoru
authors.initials: M
authors.lastname: Doita
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001843:Bone Cements / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D016867:Immunocompromised Host / Q000187:drug effects / Q000276:immunology; D007165:Immunosuppression Therapy / Q000009:adverse effects; D000069285:Infliximab; D007719:Knee Joint / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology*; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000139:chemically induced* / Q000276:immunology / Q000382:microbiology; D013530:Surgical Wound Infection / Q000139:chemically induced* / Q000276:immunology / Q000382:microbiology; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001843:Bone Cements; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab