[Septic musculoskeletal complications under immunomodulating treatment]

Area of Science:

• Rheumatology
• Infectious Diseases
• Immunology

Context:

• Patients with inflammatory rheumatic diseases, including rheumatoid arthritis (RA), experience significant morbidity and mortality from infections.
• Musculoskeletal infections, such as septic arthritis and prosthesis infections, are a relevant concern in RA patients.
• Multiple factors contribute to infection risk, including immunosuppressive therapy, joint procedures, structural damage, and comorbidities.

Purpose:

• To outline the multifactorial causes of increased infection risk in rheumatoid arthritis (RA) patients.
• To identify specific risk factors associated with septic arthritis and periprosthetic joint infections in RA.
• To highlight the role of certain medications and disease activity in infection susceptibility.

Summary:

• Rheumatoid arthritis (RA) patients have an elevated risk of septic arthritis and prosthesis infections due to factors like immunosuppression, joint punctures, surgery, structural damage, and comorbidities.
• Glucocorticoids and TNF-alpha inhibitors, particularly early in treatment, increase the risk of these infections.
• Increased disease activity and rare pathogens (e.g., Candida, mycobacteria) under immunosuppression require consideration, especially with poor antibiotic response.

Impact:

• Informing clinical practice to better manage infection risks in RA patients.
• Guiding preventative strategies and early diagnostic approaches for musculoskeletal infections in this population.
• Enhancing patient outcomes by addressing the complex interplay of disease, treatment, and infection susceptibility.