Yuasa Mao, Suyama Kazuki, Adachi Kazuya, Amano Shiho, Sano Chiaki, Ohta Ryuichi
Family Medicine, Shimane University Faculty of Medicine, Izumo, JPN.
Community Care, Unnan City Hospital, Unnan, JPN.
Cureus. 2023 Aug 7;15(8):e43057. doi: 10.7759/cureus.43057. eCollection 2023 Aug.
The use of immunosuppressive medications to treat rheumatoid arthritis may trigger the activation of latent mycobacteria, leading to infection. These infections can lead to reactive arthritis. Conversely, both reactive and rheumatoid arthritis may be encountered in the geriatric population. When such complications arise, the treatment process becomes more complicated, necessitating careful consideration of elaborate therapeutic approaches. An 83-year-old man presented to our hospital with subacute back pain and arthralgia of the extremities. The patient was diagnosed with rheumatoid arthritis combined with mycobacterial arthritis. We approached the treatment cautiously by concurrently managing tuberculosis and non-tuberculous mycobacteria (NTM), and administering methotrexate and prednisolone for rheumatoid arthritis. This treatment resulted in remission of both conditions. When treating arthritis in older adults, it is important to consider the possibility of reactive arthritis secondary to mycobacterial infection and rule out latent tuberculosis. Moreover, when rheumatoid arthritis is complicated by mycobacterial infection and during the management of rheumatoid arthritis, the possibility of arthritis exacerbation due to mycobacteria should be considered. Hence, in situations where there is a likelihood of extrapulmonary lesions stemming from Mycobacterium infection, a proactive treatment approach targeting both Mycobacterium spp. and rheumatoid arthritis is indispensable.
使用免疫抑制药物治疗类风湿性关节炎可能会引发潜伏分枝杆菌的激活，从而导致感染。这些感染可引发反应性关节炎。相反，反应性关节炎和类风湿性关节炎在老年人群中都可能出现。当出现此类并发症时，治疗过程会变得更加复杂，需要仔细考虑精心制定的治疗方法。一名83岁男性因亚急性背痛和四肢关节痛前来我院就诊。该患者被诊断为类风湿性关节炎合并分枝杆菌性关节炎。我们谨慎地进行治疗，同时管理结核病和非结核分枝杆菌（NTM），并给予甲氨蝶呤和泼尼松龙治疗类风湿性关节炎。这种治疗使两种病症都得到了缓解。在治疗老年人关节炎时，重要的是要考虑分枝杆菌感染继发反应性关节炎的可能性，并排除潜伏性结核病。此外，当类风湿性关节炎合并分枝杆菌感染时以及在类风湿性关节炎的管理过程中，应考虑分枝杆菌导致关节炎加重的可能性。因此，在存在分枝杆菌感染引起肺外病变可能性的情况下，针对分枝杆菌属和类风湿性关节炎的积极治疗方法是必不可少的。
