Mor Adam, Mitnick Hal J, Greene Jeffry B, Azar Natalie, Budnah Reynaldo, Fetto Joseph
Division of Rheumatology, New York University School of Medicine/Hospital for Joint Diseases, 301 East 17th Street, Rm. 1410, New York, NY 10003, USA.
J Clin Rheumatol. 2006 Apr;12(2):87-9. doi: 10.1097/01.rhu.0000209881.43764.5f.
Septic arthritis is a commonly reported complication of rheumatoid arthritis (RA). Tumor necrosis factor alpha (TNF-alpha) plays an important role in host defense against infection. Inhibition of its activity could therefore be anticipated to augment the risk of infection. Both opportunistic and bacterial infections have been described in patients with RA treated with anti-TNF-alpha therapy. We describe a patient who experienced 2 episodes of septic arthritis. Both occurred while the patient was on etanercept. Recurrence developed despite prolonged parenteral antibiotic. To our knowledge, this is the first report of relapsing oligoarticular methicillin-sensitive Staphylococcus aureus septic arthritis despite prolonged antibiotic treatment in a patient receiving etanercept therapy. Our case underscores the advisability of discontinuing TNF-alpha blockade in patients with septic arthritis during prolonged antimicrobial therapy.
脓毒性关节炎是类风湿关节炎（RA）常见的并发症。肿瘤坏死因子α（TNF-α）在宿主抗感染防御中起重要作用。因此，抑制其活性可能会增加感染风险。接受抗TNF-α治疗的RA患者中已报道过机会性感染和细菌感染。我们描述了一名经历了2次脓毒性关节炎发作的患者。两次发作均发生在患者使用依那西普期间。尽管长期进行肠外抗生素治疗，仍出现复发。据我们所知，这是首例在接受依那西普治疗的患者中，尽管进行了长期抗生素治疗，仍发生复发性少关节型甲氧西林敏感金黄色葡萄球菌脓毒性关节炎的报告。我们的病例强调了在长期抗菌治疗期间，对于患有脓毒性关节炎的患者停用TNF-α阻断剂的可取性。
