title: Clinical factors related to the efficacy and complications of orthopedic surgery for rheumatoid arthritis with infliximab.
abstract: OBJECTIVE
  To determine what clinical factors relating to efficacy besides complications of orthopedic surgery for patients treated with anti-tumor necrosis factor (TNF)-α therapy (infliximab), we analyzed the clinical data of 52 cases of orthopedic surgery, such as total hip arthroplasy (THA), total knee arthroplasty (TKA), total shoulder arthroplasy (TSA), total elbow arthroplasty (TEA), arthroscopic synovectomy, foot arthroplasty, spine surgery, hand surgery and fracture.
  
  
  METHODS
  We analyzed clinical factors including age, disease duration, preoperative C-reactive protein (CRP), disease activity score (DAS)-28, matrix metalloproteinase (MMP)-3, and rheumatoid arthritis particle-agglutination (RAPA) in 52 cases of rheumatoid arthritis (RA) undergoing orthopedic surgery. For complications of orthopedic surgery, signs of postoperative infection were recorded, including rubor, discharge, systemic infection and frequencies of wound dehiscence, as well as the incidence of any surgical complication requiring a secondary revision procedure were measured.
  
  
  RESULTS
  Signs of infection or surgical complications occurred in two of 52 patients (3.8%). There is significant correlation between RAPA and improvement of CRP 3 months after surgery; however, there is no correlation between infection and clinical factors including age, disease duration, preoperative CRP, MMP-3, RAPA and the period until surgery after infliximab infusion.
  
  
  CONCLUSIONS
  Infliximab did not increase the risk of either infections or surgical complications occurring in patients with RA within 1 year of orthopedic surgery. Improvement of CRP after surgery is likely to be due to infliximab for high RAPA in RA patients.
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Hayata
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Kanbe
authors.forename: Junji
authors.initials: J
authors.lastname: Chiba
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakamura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Inoue
authors.forename: Kaori
authors.initials: K
authors.lastname: Hobo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000503:physiopathology* / Q000601:surgery; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis; D004359:Drug Therapy, Combination; D005260:Female; D006304:Health Status; D006801:Humans; D000069285:Infliximab; D008297:Male; D019278:Matrix Metalloproteinase 3 / Q000097:blood; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology; D012086:Reoperation; D012217:Rheumatoid Factor / Q000097:blood; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D002097:C-Reactive Protein; D012217:Rheumatoid Factor; D000069285:Infliximab; D019278:Matrix Metalloproteinase 3