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Septic arthritis induced by Streptococcus pneumoniae occurring in rheumatoid arthritis treated with abatacept and

Kazuya Abe1,2, Yuichi Ishikawa1,3,4, Tatsuro Takahashi1

  • 1Department of Rheumatology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan.

Modern Rheumatology Case Reports
|September 28, 2022
PubMed

Insights

Biological disease-modifying antirheumatic drugs (bDMARDs) may increase the risk of pneumococcal septic arthritis in rheumatoid arthritis (RA) patients. Pneumococcal vaccination and careful bDMARD management are recommended for RA patients in remission.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Rheumatoid arthritis (RA) patients, especially the elderly, are susceptible to septic arthritis, commonly caused by Staphylococcus aureus.
  • Biological disease-modifying antirheumatic drugs (bDMARDs) are frequently used for RA management, but their role in specific infections like pneumococcal septic arthritis remains unclear.
  • Streptococcus pneumoniae (pneumococcus) is a rare but serious cause of septic arthritis.

Observation:

  • A 64-year-old female RA patient treated with bDMARDs (abatacept) and methotrexate, who was in remission and unvaccinated against pneumococcus, developed pneumococcal septic arthritis.
  • The patient presented with left ankle arthralgia and fever, with positive blood and synovial fluid cultures for pneumococcus.
  • Pneumococcal urinary antigen test was also positive, confirming the diagnosis.

Findings:

  • This case report details the first instance of pneumococcal septic arthritis in an RA patient treated with abatacept.
  • The findings suggest a potential risk association between bDMARD use and pneumococcal septic arthritis in RA patients.
  • The patient successfully recovered after antibiotic treatment.

Implications:

  • Encouraging pneumococcal vaccination is crucial for RA patients on bDMARDs.
  • Consideration should be given to spacing or discontinuing bDMARDs in RA patients who have achieved remission to mitigate the risk of severe infections.
  • Further research is warranted to elucidate the precise relationship between bDMARDs and pneumococcal infections in RA.
Keywords:
Streptococcus pneumoniaeSeptic arthritisabataceptinvasive pneumococcal diseaserheumatoid arthritis

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