Ren Yi, Biedermann Lara, Gwinner Clemens, Perka Carsten, Kienzle Arne
Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité University Hospital, 10117 Berlin, Germany.
Berlin Institute of Health, Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany.
J Pers Med. 2022 May 17;12(5):810. doi: 10.3390/jpm12050810.
Current diagnostic standards for PJI rely on inflammatory markers that are typically elevated in autoimmune diseases, thus making the diagnosis of PJI in patients with rheumatoid arthritis and joint replacement particularly complicated. There is a paucity of data on differentiating PJI from rheumatoid arthritis in patients with previous arthroplasty. In this study, we retrospectively analyzed the cases of 17 patients with rheumatoid arthritis and 121 patients without rheumatoid disease who underwent surgical intervention due to microbiology-positive PJI of the hip or knee joint. We assessed clinical patient characteristics, laboratory parameters, and prosthesis survival rates in patients with and without rheumatoid arthritis and acute or chronic PJI. ROC analysis was conducted for the analyzed parameters. In patients with chronic PJI, peripheral blood CRP ( = 0.05, AUC = 0.71), synovial WBC count ( = 0.02, AUC = 0.78), synovial monocyte cell count ( = 0.04, AUC = 0.75), and synovial PMN cell count ( = 0.02, AUC = 0.80) were significantly elevated in patients with rheumatoid arthritis showing acceptable to excellent discrimination. All analyzed parameters showed no significant differences and poor discrimination for patients with acute PJI. Median prosthesis survival time was significantly shorter in patients with rheumatoid arthritis ( = 0.05). In conclusion, routinely used laboratory markers have limited utility in distinguishing acute PJI in rheumatoid patients. In cases with suspected chronic PJI but low levels of serum CRP and synovial cell markers, physicians should consider the possibility of activated autoimmune arthritis.
目前人工关节感染（PJI）的诊断标准依赖于炎症标志物，而这些标志物在自身免疫性疾病中通常会升高，因此在类风湿性关节炎和关节置换患者中诊断PJI特别复杂。关于在既往接受过关节置换术的患者中区分PJI和类风湿性关节炎的数据很少。在本研究中，我们回顾性分析了17例类风湿性关节炎患者和121例无类风湿性疾病患者的病例，这些患者因髋关节或膝关节微生物学阳性的PJI接受了手术干预。我们评估了有或无类风湿性关节炎以及急性或慢性PJI患者的临床特征、实验室参数和假体生存率。对分析的参数进行了ROC分析。在慢性PJI患者中，类风湿性关节炎患者的外周血CRP（P = 0.05，AUC = 0.71）、滑膜白细胞计数（P = 0.02，AUC = 0.78）、滑膜单核细胞计数（P = 0.04，AUC = 0.75）和滑膜PMN细胞计数（P = 0.02，AUC = 0.80）显著升高，显示出可接受至优秀的区分度。所有分析参数在急性PJI患者中均无显著差异且区分度差。类风湿性关节炎患者的假体中位生存时间显著缩短（P = 0.05）。总之，常规使用的实验室标志物在区分类风湿性患者的急性PJI方面效用有限。在怀疑为慢性PJI但血清CRP和滑膜细胞标志物水平较低的病例中，医生应考虑自身免疫性关节炎激活的可能性。
