Microbiological and immunological monitoring in polyarticular rheumatoid arthritis after joint replacement

History and admission findings: A 51-year-old man with polyarticular rheuma toid arthritis since the age of 10 years, which had required three total jo int replacements, presented in a generally good condition for replacement o f the left elbow joint, which was swollen and had reduced movement. Treatment and course: The postoperative condition was without complication until the 7th day when arthritic signs set in, interpreted as part of the u nderlying disease, and cortisone was administered. After microbiological te sts had been done and the patient's general state had deteriorated, antibio tic treatment with flucloxacillin and gentamycin as well as local irrigatio n and suction-drainage of all involved joints was started. Granulocyte and monocyte functions were analysed, Staphylococcal isolates from the patient induced reduced "respiratory burst" activity of the neutrophil granulocytes , apparently the cause of the septic dissemination. He was discharged on th e 32. postoperative day, to be followed-up as an out-patient. Conclusion: Both adequate antibiotic administration and, especially, thorou gh local reduction of pathogens are needed for efficacious treatment. Rapid restoration of granulocyte function and of the "immunocompetence" of monoc ytes within normal limits are part of the reason for a good therapeutic res ponse. This indicates the need for up-to-date preoperative immunological di agnosis in patients with suppressed immunity to assess the risk of infectio n and thus plan elective intervention.