Abstract
High rates of Staphylococcus aureus are reported in prosthetic joint infection (PJI) in rheumatoid arthritis (RA). RA patients are considered to have a high risk of infection with bacteria of potentially oral or dental origin. One thousand four hundred forty-three revisions for infection were reported to the Norwegian Arthroplasty Register (NAR) from 1987 to 2007. For this study 269 infection episodes in 255 OA patients served as control group. In the NAR we identified 49 infection episodes in 37 RA patients from 1987 to 2009. The RA patients were, on average, 10 years younger than the OA patients and there were more females (70% versus 54%). We found no differences in the bacterial findings in RA and OA. A tendency towards a higher frequency of Staphylococcus aureus (18% versus 11%) causing PJI was found in the RA patients compared to OA. There were no bacteria of potential odontogenic origin found in the RA patients, while we found 4% in OA. The bacteria identified in revisions for infection in THRs in patients with RA did not significantly differ from those in OA. Bacteria of oral or dental origin were not found in infected hip joint replacements in RA.
Highlights
Patients with rheumatoid arthritis (RA) often undergo joint surgery, especially prosthetic joint replacements
The odds for culturing CoNS compared to S. aureus in RA patients was lower than for OA patients (OR = 0.4, 95% CI: 0.1–1.0, P = 0.06) indicating that there were more S. aureus compared to CoNS in the RA group
Our finding of a high percentage of culture negative infections (31–37%) are caused by prior courses of antimicrobial therapy, inappropriate samples or wrong diagnosis. Another finding in the present study was a tendency towards a higher frequency of S. aureus than, for example, CoNS in RA patients compared to OA patients, the percentage of infections caused by S. aureus was not as high as 37%, reported by Berbari and coworkers, but in their study knee as well as hip replacements were included [10]
Summary
Patients with rheumatoid arthritis (RA) often undergo joint surgery, especially prosthetic joint replacements. In the present paper we seek to evaluate and compare bacterial findings in prosthetic hip joint infections in RA patients versus OA patients, for the following reasons. PJIs in patients with RA have been reported to be caused by Staphylococcus aureus (S. aureus) in as much as 37% [10]. This could be a result of relatively high carriage rates of S. aureus in RA patients [11,12,13]. If this is the case, eradication of nasal S. aureus with intranasal mupirocin ointment perioperatively might offer an attractive
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