Salar O, Baker B, Kurien T, Taylor A, Moran C
Nottingham University Hospitals NHS Trust, UK.
Ann R Coll Surg Engl. 2014 Mar;96(2):e11-2. doi: 10.1308/003588414X13814021678196.
Immunosuppressants have been the mainstay of treatment for certain inflammatory joint conditions for many years. Developments in this field, namely biological treatments, have led to a change in the classical presentation of acute bone, joint and soft tissue infections. The normal findings of severe pain and tenderness on examination may be absent or simply mimic a typical exacerbation of the chronic joint condition. A minimally raised white cell count and elevated C-reactive protein in the absence of systemic signs of infection may be interpreted as further evidence for the diagnosis of an exacerbation of inflammatory arthritis. We present a unique case of recurrent polyarticular septic arthritis in a patient treated with immunosuppression for refractory rheumatoid arthritis. We hope this article will enable doctors to appreciate and recognise the changing face of septic arthritis in the modern era of immunosuppressant treatments.
多年来，免疫抑制剂一直是某些炎性关节疾病的主要治疗手段。该领域的发展，即生物治疗，已导致急性骨、关节和软组织感染的典型表现发生变化。检查时严重疼痛和压痛的正常表现可能不存在，或者仅仅类似慢性关节疾病的典型加重。在没有全身感染迹象的情况下，白细胞计数略有升高和C反应蛋白升高，可能被解释为炎性关节炎加重诊断的进一步证据。我们报告了一例独特的复发性多关节化脓性关节炎病例，患者因难治性类风湿关节炎接受免疫抑制治疗。我们希望本文能使医生认识并识别免疫抑制剂治疗现代 era 中化脓性关节炎不断变化的面貌。
