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Case Reports
. 2023 Feb 28;15(2):e35622.
doi: 10.7759/cureus.35622. eCollection 2023 Feb.

Rheumatoid Arthritis-Linked Artificial Joint Infections Leading to Amputations

Laurence Stolzenberg  1 , Austin Huang  2 , Mohammad Usman  3 , Alexis Koch  4 , John Stevenson  5 , Colby Kihara  6 , Jason Seale  7
Affiliations
Case Reports

Rheumatoid Arthritis-Linked Artificial Joint Infections Leading to Amputations

Laurence Stolzenberg et al. Cureus. .

Abstract

Rheumatoid arthritis (RA) is a common autoimmune condition that can rarely cause more serious complications, such as permanent joint damage or infection, and may pose a significant additional risk during certain routine procedures. One major consequence of RA is that it can lead to serious and permanent joint damage requiring arthroplasty. Additionally, RA is a known cause of infection, with orthopedic prosthetic joint infections (PJIs) being documented. We explore one such serious case of a patient with long-term RA and a left knee joint replacement who presented to the emergency room with a serious PJI. History revealed that he repeatedly was affected by infections and had an extensive and severe clinical course, including nine revision surgeries. After a physical examination, imaging was performed, which further supported the diagnosis of joint infection. Considering the extensive number of attempts to salvage the joint, clinicians decided an above-knee amputation was necessary. This case highlights the fact that RA both increases the need for orthopedic arthroplasties and the risk of complications from these procedures, complicating clinical decision-making for physicians. Additionally, this patient had other underlying medical conditions and social habits that may have contributed to his severe clinical course, and we hope to explore these, discuss possible methods of modifying them, and assist clinicians in not only better treating similar patients but also emphasizing the importance of further developing standardized predictive algorithms and scoring tools.

Keywords: amputation; immune suppressing medications; joint infections; orthopedic surgery; orthopedics; prosthetic joint infection; rheumatoid arthritis; sulfasalazine.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT of the left lower extremity, transverse cut, showing gas bubbles (green arrow) in the fluid collection, suggestive of an abscess.
CT, computed tomography
Figure 2
Figure 2. CT of the left lower extremity, sagittal cut, showing gas bubbles (green arrow) in the fluid collection, suggestive of an abscess.
CT, computed tomography
See this image and copyright information in PMC

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