Vol.21 No.5

Case Report

Anti-tumor necrosis factor therapy in rheumatoid arthritis patients with a history of deep prosthetic joint infection: a report of four cases

Authors

Yuji Hirano1 , Toshihisa Kojima2 , Yasuhide Kanayama2 , Tomone Shioura3 , Masatoshi Hayashi2 , Seiji Tsuboi3 , Naoki Ishiguro2

  • Department of Rheumatology, Toyohashi Municipal Hospital, 50 Hakken-nishi, Aotake-cho, Toyohashi, 441-8570, Japan
  • Department of Orthopedic Surgery and Rheumatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Department of Rheumatology, Shizuoka Kosei Hospital, Shizuoka, Japan
Received:

14 December 2010

Accepted:

10 February 2011

Published online:

4 March 2011

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Abstract

Four rheumatoid arthritis patients (three women and one man) who had a history of prosthetic joint infection were treated with anti-tumor necrosis factor (TNF) agents after treatment of the infection. The anti-TNF therapy was subsequently discontinued in three patients. The reason for discontinuation was not the reactivation of infection, but disseminated tuberculosis, Pneumocystis jiroveci pneumonia, and interstitial pneumonia, respectively. These cases suggest that a history of prosthetic joint infection may be a contraindication for treatment with anti-TNF agents.

Key words

Rheumatoid arthritis - Anti-tumor necrosis factor therapy - Prosthetic joint infection - Disseminated tuberculosis - Pneumocystis pneumonia