Stolzenberg Laurence, Huang Austin, Usman Mohammad, Koch Alexis, Stevenson John, Kihara Colby, Seale Jason
Orthopedic Surgery, Alabama College of Osteopathic Medicine, Dothan, USA.
Neurology, Alabama College of Osteopathic Medicine, Dothan, USA.
Cureus. 2023 Feb 28;15(2):e35622. doi: 10.7759/cureus.35622. eCollection 2023 Feb.
Rheumatoid arthritis (RA) is a common autoimmune condition that can rarely cause more serious complications, such as permanent joint damage or infection, and may pose a significant additional risk during certain routine procedures. One major consequence of RA is that it can lead to serious and permanent joint damage requiring arthroplasty. Additionally, RA is a known cause of infection, with orthopedic prosthetic joint infections (PJIs) being documented. We explore one such serious case of a patient with long-term RA and a left knee joint replacement who presented to the emergency room with a serious PJI. History revealed that he repeatedly was affected by infections and had an extensive and severe clinical course, including nine revision surgeries. After a physical examination, imaging was performed, which further supported the diagnosis of joint infection. Considering the extensive number of attempts to salvage the joint, clinicians decided an above-knee amputation was necessary. This case highlights the fact that RA both increases the need for orthopedic arthroplasties and the risk of complications from these procedures, complicating clinical decision-making for physicians. Additionally, this patient had other underlying medical conditions and social habits that may have contributed to his severe clinical course, and we hope to explore these, discuss possible methods of modifying them, and assist clinicians in not only better treating similar patients but also emphasizing the importance of further developing standardized predictive algorithms and scoring tools.
类风湿性关节炎（RA）是一种常见的自身免疫性疾病，很少会引发更严重的并发症，如永久性关节损伤或感染，并且在某些常规手术过程中可能带来显著的额外风险。RA的一个主要后果是它会导致严重且永久性的关节损伤，需要进行关节置换术。此外，RA是已知的感染病因，已有骨科人工关节感染（PJI）的记录。我们探讨了这样一个严重病例，一名患有长期RA且左膝关节置换的患者因严重的PJI就诊于急诊室。病史显示他反复受到感染，经历了广泛且严重的临床过程，包括九次翻修手术。体格检查后进行了影像学检查，进一步支持了关节感染的诊断。考虑到为挽救关节进行了大量尝试，临床医生决定进行膝上截肢是必要的。这个病例凸显了这样一个事实，即RA既增加了骨科关节置换术的需求，也增加了这些手术并发症的风险，使医生的临床决策变得复杂。此外，该患者还有其他基础疾病和社会习惯，可能导致了他严重的临床过程，我们希望探讨这些因素，讨论改变它们的可能方法，并协助临床医生不仅更好地治疗类似患者，还强调进一步开发标准化预测算法和评分工具的重要性。
