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Diagnostic Challenges and Risk Stratification of Periprosthetic Joint Infection in Patients with Inflammatory
Paweł Kasprzak1,2, Wiktoria Skała3, Mariusz Gniadek2
1Department of Orthopedics and Traumatology, Medical University of Warsaw, 4 W.H. Lindleya St, 02-005 Warsaw, Poland.
Journal of Clinical Medicine
|June 26, 2025
Summary
Diagnosing periprosthetic joint infection (PJI) in inflammatory arthritis (IA) is difficult. New biomarkers like BPI and ELA-2 show promise for improved PJI detection in IA patients.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Infectious Diseases
Background:
- Accurate periprosthetic joint infection (PJI) detection is challenging in inflammatory arthritis (IA) patients, including rheumatoid arthritis (RA).
- Overlapping inflammatory parameters and immunosuppressive therapies complicate PJI diagnosis in IA.
Purpose of the Study:
- To review current diagnostic challenges and emerging biomarkers for PJI in patients with IA.
- To identify strategies for improving PJI diagnosis in this complex patient population.
Main Methods:
- A narrative review of PubMed/MEDLINE literature from 2010-2025.
- Search terms included "periprosthetic joint infection", "inflammatory arthritis", "rheumatoid arthritis", "diagnosis", "biomarkers", "synovial fluid", and "immunosuppression".
- 50 studies were included in the final analysis.
Main Results:
- IA patients with PJI are often younger, female, with higher comorbidity burden, and increased false-positive histology and culture-negative infections.
- Standard biomarkers (serum CRP, ESR, synovial fluid WBC, and PMN%) have low to moderate diagnostic value in IA, with different optimal thresholds than MSIS.
- Alpha-defensin shows superior performance; novel markers (serum BPI, ELA-2, synovial CRP, calprotectin) and PCR show increasing potential.
Conclusions:
- Disease and treatment confounders significantly hinder PJI diagnosis in IA patients.
- IA-specific diagnostic approaches and adjusted biomarker thresholds are necessary.
- Emerging biomarkers, particularly BPI, ELA-2, and synovial CRP, warrant further validation for improved PJI detection and perioperative management.
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