ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2450

Prosthetic Joint Infection in Patients with Rheumatoid Arthritis

John Fredy Jaramillo Gallego1, Aurelia Luissi1, Marina Scolnik2, Javier Rosa1 and Enrique R Soriano2, 1Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Capital Federal, Argentina, 2Rheumatology Unit, Internal Medicine Service. Hospital Italiano Buenos Aires. Argentina, Buenos Aires, Argentina

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with rheumatoid arthritis (RA) have been shown to have an increased susceptibility to the development of prosthetic joint infection (PJI) after Total Hip or Knee Arthroplasty (THA/TKA). Our aim was to compare the risk of PJI after THA or TKA in patients with RA versus controls.

Methods: All patients with RA (ACR 1987/ACR 2010 criteria) who had undergone joint replacement of the hip or knee in our hospital between 01/01/2008 and 12/31/2016 were included; and compared with patients matched by age and sex (2 to 1), without diagnosis of RA, also subjected to hip or knee joint replacement in the same period. Clinical records were reviewed, collecting demographic data, RA characteristics, treatments and comorbidities. Patients with PJI were identified in cases and controls. Descriptive statistics were performed and risk factors associated with infection were analyzed by logistic regression.

Results: We identified 50 patients with RA who underwent joint replacement surgery in that period, 92% women, mean age at diagnosis of 48.9 years (SD 17.2) and mean age at the time of joint surgery of 60.3 years (DS 15.7) (see table). The cause of joint replacement in control patients was osteoarthritis in 79% of cases. The type of joint surgery in patients with RA was TKA in 27 patients, THA in 20 patients and total hip and knee arthroplasty in 3 patients. At the time of surgery, RA patients were in treatment with: corticosteroids 56%, conventional DMARDs 72% and biologics 34%. DMARD or biological treatment was suspended because of the surgery in 34% of patients. 3 patients with RA (6%, 95% CI: 1.9-17.3) and 2 control patients (2%, 95% CI: 0.5-7.8) had prosthetic infection (p = 0.2). All prosthetic infections in patients with RA resolved with prolonged antibiotic treatment, while 1 of the 2 control patients required prosthetic replacement (p = 0.17). There was no association between having a PJI with previous comorbidities or with any of the RA treatments.

Conclusion: 6% of the patients with RA undergoing THA/TKA had a prosthetic infection, without difference with the control group.

Rheumatoid Arthritis

(n=50)

Other causes of joint replacement

(n=100)

P

Female sex, % (CI 95%)

92 (80-97)

92 (85-96)

1

Age at the time of surgery, years, mean (SD)

60.3 (15.7)

59.9 (13.8)

0.9

Follow-up time in the hospital, years, median (IQR)

9.7 (3.7-14.7)

4.9 (2.2-10.6)

0.001

Type of surgery, n (%)

– Total Knee Arthroplasty (TKA)

27 (54)

26 (26)

0.001

– Total Hip Arthroplasty (THA)

20 (40)

72 (72)

<0.001

– Total Hip and Knee Arthroplasty

3 (6)

2 (2)

0.2

Time of evolution of RA at the time of THA, years, median (IQR)

10.8 (2.9-15.7)

—

—

Time of evolution of RA at the time of TKA, years, median (IQR)

13.3 (4.7-17.8)

—

—

Preoperative medications, % (CI 95%)

—

—

– Glucocorticoids

56 (41.8-69.2)

—

—

– csDMARD

72 (57.8-82.8)

—

—

– bDMARD

34 (22.1-48.4)

—

—

Treated with glucocorticoids, years, median (IQR)

3 (0-7)

—

—

Suspension of medication prior to surgery

34 (22.1-48.4)

—

—

Comorbidity, % (CI)

– Diabetes mellitus

8 (2.9-19.7)

11 (6.1-18.9)

0.56

– Arterial hypertension

50 (36.2-63.7)

47 (37.3-56.9)

0.73

– Dyslipidemia

28 (17.2-42.2)

21(14.1-30.2)

0.34

– Active smoker

12 (5.4-24.5)

11 (6.1-18.9)

0.86

– Previous articular surgery

18 (9.5-31.4)

11 (6.1-18.9)

0.23

Prosthetic Joint Infection, % (CI)

6 (1.9-17.3)

2 (0.5-7.8)

0.2

Disclosure: J. F. Jaramillo Gallego, None; A. Luissi, None; M. Scolnik, None; J. Rosa, None; E. R. Soriano, AbbVie, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer Inc, Roche, UCB, 2,AbbVie, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, 5,AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sandoz, UCB, 8.

To cite this abstract in AMA style:

Jaramillo Gallego JF, Luissi A, Scolnik M, Rosa J, Soriano ER. Prosthetic Joint Infection in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/prosthetic-joint-infection-in-patients-with-rheumatoid-arthritis/. Accessed .

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