Autoimmune and Inflammatory Diseases Associated With Increased Periprosthetic Joint Infection Risk: A Narrative...

Area of Science:

• Orthopedics
• Rheumatology
• Infectious Diseases

Background:

• Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty.
• Patients with autoimmune diseases like rheumatoid arthritis (RA), psoriasis, and systemic lupus erythematosus (SLE) have increased PJI risk due to immune dysregulation, skin barrier issues, and immunosuppressive treatments.

Purpose of the Study:

• To review the pathophysiology, risk factors, microbiology, and perioperative management of PJI in patients with autoimmune and inflammatory diseases.
• To synthesize current evidence on PJI risk quantification and management strategies for this vulnerable patient group.

Main Methods:

• A narrative review synthesizing data from cohort studies, registry analyses, mechanistic investigations, and clinical practice guidelines.
• Analysis of comparative risk data for RA, psoriasis, and SLE patients undergoing arthroplasty.
• Examination of the impact of biologic therapy and glucocorticoid use on PJI risk.
• Review of distinct microbiologic profiles, including culture-negative infections and MRSA colonization.

Main Results:

• RA patients had significantly higher PJI risk (HR 4.08, OR 1.47 vs. osteoarthritis).
• Psoriasis and SLE patients also showed elevated PJI risks (OR 1.63 and HR 2.74, respectively).
• Perioperative continuation of biologic therapy (OR 3.46) and chronic glucocorticoid use increased PJI odds; MRSA colonization (OR 3.43) also elevated risk.
• Culture-negative infections were noted in 28%-38% of RA patients.

Conclusions:

• Autoimmune disease patients face substantially higher PJI risks, necessitating tailored perioperative strategies.
• Management involves careful consideration of immunosuppressive therapies, with temporary interruption of biologics and individualized medication adjustments.
• Multidisciplinary collaboration is essential for optimizing PJI prevention and treatment in this high-risk population.