The changing face of septic arthritis complicating rheumatoid arthritis in the era of biotherapies. Retrospective single-center study over 35years.
OBJECTIVE
To see whether the frequency and features of septic arthritis (SA) complicating rheumatoid arthritis (RA) have changed over the last 35years.


METHODS
This retrospective single-center study included all patients hospitalized at the rheumatology department for SA bacteriologically documented by synovial fluid and/or blood culture samples. The periods 1979-2002 (before biotherapies) and 2003-2013 (the era of biotherapies) were compared.


RESULTS
Between 1979 and 2013, 64/514 (12.5%) SA presented with a RA - 21/157 (13.4%) in the 2003-2013 period and 43/357 (12.0%) in the 1979-2002 period. Over the past decade, median age of RA SA patients increased (61 vs. 68 years; P<0.02) and predominant gender became males (52% vs. 40%). The features of the RA remained unchanged: history (18 vs. 16years), rheumatoid factor (95% vs. 87%), and corticosteroids (91% vs. 81%). Over the last decade 24% (vs. 0; P<0.003) of the patients received a biologic DMARD: etanercept (n=2), adalimumab (n=1), rituximab (n=1), tocilizumab (n=1). Proportion of polyarticular infection had decreased strongly (9.5% vs. 37%; P<0.02). Proportion of Staphyloccus aureus infections remained stable, but there was a higher incidence of MRSA infections (31 vs. 6%; P<0.05). Blood cultures less often tested positive (29% vs. 47%; NS). Case fatality rate had fallen slightly in RA SA (5% vs. 9%; NS), but not in non-RA SA cases (7% vs. 6%; NS).


CONCLUSIONS
This study brings reassuring findings - in the era of biotherapies, the rate of septic arthritis amongst patients with RA has not increased, and the most severe septic polyarticular forms are on the decline.
Department of Rheumatology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France. Electronic address: jjdubost@chu-clermontferrand.fr.
Jean-Jacques
JJ
Dubost
Biostatistics Unit, Clermont-Ferrand University Hospital, 63006 Clermont-Ferrand, France.
Bruno
B
Pereira
Department of Rheumatology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
Anne
A
Tournadre
Department of Rheumatology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
Zuzana
Z
Tatar
Department of Rheumatology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
Marion
M
Couderc
Department of Rheumatology, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
Martin
M
Soubrier
D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D001688:Biological Products / Q000009:adverse effects* / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015331:Cohort Studies; D000068800:Etanercept / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D000069283:Rituximab / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate
D061067:Antibodies, Monoclonal, Humanized; D001688:Biological Products; D000069283:Rituximab; D000068879:Adalimumab; C502936:tocilizumab; D000068800:Etanercept
Anti-TNF therapy; Biotherapy; Rheumatoid arthritis; Septic arthritis