naa a22 4500 510760481 CHVBK 20180411083137.0 cr unu---uuuuu 180411e20130701xx s 000 0 eng 10.1007/s11420-013-9338-8 doi (NATIONALLICENCE)springer-10.1007/s11420-013-9338-8 Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: a Review of Risk Factors and Current Approaches to Diagnosis and Management [Elektronische Daten] [Todd Morrison, Mark Figgie, Andy Miller, Susan Goodman] Background: Prevention, early identification, and effective management of periprosthetic joint infection (PJI) in patients with inflammatory joint disease (IJD) present unique challenges for physicians. Discontinuing disease-modifying anti-rheumatoid drugs (DMARDs) perioperatively may reduce immunosuppression and infection risk at the expense of increasing disease flares. Interpreting traditional diagnostic markers of PJI can be difficult due to disease-related inflammation. Purposes: This review is designed to answer how to (1) manage immunosuppressive/DMARD therapy perioperatively, (2) diagnose PJI in patients with IJD, and (3) treat PJI in this population. Methods: The PubMed database was searched for relevant articles with subsequent review by independent authors. Results: While there is evidence to support the use of methotrexate perioperatively in RA patients, it remains unclear whether using anti-tumor necrosis factor medications perioperatively increases the risk of surgical site infections. Serum erythrocyte sedimentation rate and C-reactive protein can be useful for diagnosis of PJI in this population, but only as part of comprehensive workup that ultimately relies upon sampling of joint fluid. Management of PJI depends on several clinical factors including duration of infection and the likelihood of biofilm presence, the infecting organism, sensitivity to antibiotic therapy, and host immune status. The evidence suggests that two-stage revision or resection arthroplasty is more likely to eradicate infection, particularly when MRSA is the pathogen. Conclusion: Immunosuppression and baseline inflammatory changes in the IJD population can complicate the prevention, diagnosis, and treatment of PJI. Understanding the increase in risk associated with IJD and its treatment is essential for proper management when patients undergo lower extremity arthroplasty. Hospital for Special Surgery, 2013 periprosthetic joint infection nationallicence inflammatory arthritis nationallicence total joint arthroplasty nationallicence Morrison Todd Jefferson Medical College, 1025 Walnut Street, 19107, Philadelphia, PA, USA aut Figgie Mark Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Miller Andy Division of Infectious Diseases, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut Goodman Susan Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut HSS Journal ® Springer US; http://www.springer-ny.com 9/2(2013-07-01), 183-194 1556-3316 9:2<183 2013 9 11420 https://doi.org/10.1007/s11420-013-9338-8 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11420-013-9338-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Morrison Todd Jefferson Medical College, 1025 Walnut Street, 19107, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Figgie Mark Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Miller Andy Division of Infectious Diseases, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 700 1- Goodman Susan Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA aut NATIONALLICENCE 773 0- HSS Journal ® Springer US; http://www.springer-ny.com 9/2(2013-07-01), 183-194 1556-3316 9:2<183 2013 9 11420 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer