Pyarthrosis in patients with rheumatoid arthritis: A detailed analysis of 10 cases and literature review

Objectives: 1) To analyze the clinical features and outcome of patients wit h rheumatoid arthritis and pyarthrosis seen in a rheumatology department du ring a 9-year period; 2) To review the available literature about this asso ciation in the last decade. Methods: From the database of our department, we collected all hospitalized cases of infectious arthritis in native joints between January 1990 and De cember 1998. In 10 cases (27%), pyarthrosis occurred in patients with rheum atoid arthritis. A detailed analysis of each patient was performed. The lit erature was reviewed by using MEDLINE from 1990 to 1999. Results: The mean age of patients was 63.2 years; six were female. Most pat ients had long-standing disease and poor functional class, and all received glucocorticoid treatment. Mean diagnostic delay was 7.3 days. Causative or ganisms were Staphylococcus aureus (4 cases), gram-negative bacilli (3 case s), anaerobic bacteria (2 cases), and Streptococcus pneumoniae (n = 1). Two patients died. In all but two patients who survived, joint function worsen ed. Conclusions: Rheumatoid arthritis is a relevant host-related risk factor fo r septic arthritis. Pyarthrosis in these patients is associated with consid erable morbidity and mortality. Copyright (C) 2000 by W.B. Saunders Company .