[Septic musculoskeletal complications under immunomodulating treatment].

Infections are an important cause of morbidity and mortality in patients with inflammatory rheumatic diseases. Among these, musculoskeletal infections represent a relevant proportion as patients with rheumatoid arthritis face an increased risk of developing septic arthritis and prosthesis infections. The causes are multifactorial. In addition to immunosuppressive treatment, risk factors of infection in rheumatoid arthritis (RA) patients include repeated intra-articular joint punctures, an increased rate of joint replacement surgery, damaged joint structure and comorbidities. The use of glucocorticoids and tumor necrosis factor alpha (TNF-alpha) inhibitors, especially in the first 6 months of treatment, increase the risk of septic arthritis and periprosthetic joint infections. In addition, an increased disease activity could also be identified as a risk factor. Under immunosuppressive therapy rare pathogens such as Candida and mycobacteria can cause the infection and should be considered when there is a lack of clinical response to antibiotic treatment.