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Late infection of total knee arthroplasty inflamed by anti-TNFα, Infliximab therapy in rheumatoid arthritis

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Abstract

We report a case of sudden onset of late infection after TKA inflamed by anti-TNFα 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.

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Fig. 1
Fig. 2

Abbreviations

TNFα:

Tumor necrosis factor alpha

RA:

Rheumatoid arthritis

TKA:

Total knee arthroplasty

MSSA:

Methicillin susceptible staphylococcus aureus

MTX:

Methotrexate

CRP:

C reactive protein

DAS:

Disease activity score

OA:

Osteoarthritis

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Acknowledgments

Informed consent for the publication of data concerning this case was received from the patient. The authors thank the patient for her permission to use her case to highlight the issues noted in this article and to use her radiographs to demonstrate these issues. Additionally the authors thank Ms. Tubby for her help in preparing the manuscript.

Conflict of interest statement

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Osaka Koseinenkin Hospital, Osaka, Japan

    Takashi Yurube, Koichiro Takahi, Hajime Owaki & Takeshi Fuji

  2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Takashi Yurube, Masahiro Kurosaka & Minoru Doita

Authors
  1. Takashi Yurube
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  2. Koichiro Takahi
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  3. Hajime Owaki
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  4. Takeshi Fuji
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  5. Masahiro Kurosaka
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  6. Minoru Doita
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Correspondence to Takashi Yurube.

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Yurube, T., Takahi, K., Owaki, H. et al. Late infection of total knee arthroplasty inflamed by anti-TNFα, Infliximab therapy in rheumatoid arthritis. Rheumatol Int 30, 405–408 (2010). https://doi.org/10.1007/s00296-009-0948-x

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  • DOI: https://doi.org/10.1007/s00296-009-0948-x

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