Case reportRheumatoid arthritis, foot infection and tumour necrosis factor alpha inhibition—a case history
Section snippets
Case history
A 68-year-old Caucasian female patient with an eight-year history of rheumatoid arthritis (RA) was referred to our clinic for routine podiatry care. Her medical history apart from the rheumatoid arthritis was unremarkable. The RA was currently controlled with Methotrexate (15 mg weekly) and infusions of the tumour necrosis factor alpha (TNF∝) inhibitor Infliximab every two months; the patient also takes folic acid. At presentation, there were areas of inflammation over the dorsum of the first
Discussion
Rheumatoid arthritis (RA) is a chronic, progressive, systemic, usually symmetrical, inflammatory polyarthritis [1], [2]. It predominantly affects the peripheral joints leading to progressive disability and increased mortality [3]. RA is primarily characterised by immunological and inflammatory changes in the synovium associated with joint erosion, deformity and destruction [4]. The goals of medical management in RA are to control pain, limit disease progression, preserve function and allow the
Conclusions
This report highlights a number of issues in patients who present with infected lesions while taking anti TNF∝ medication. In particular;
- •
Awareness that immunosuppression with anti TNF∝ agents may allow rapid spread of infection and tissue necrosis.
- •
Communication with the patient's Consultant Rheumatologist is essential.
- •
Wound swabs and, where clinically indicated, X-rays, should be arranged as a matter of course.
- •
Careful consideration is required regarding the route of administration of antibiotic
References (15)
Does the sex of rheumatoid arthritis patients matter?
Lancet
(1998)- et al.
Infliximab (chimeric anti-tumour factor ∝ monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial
Lancet
(1999) - et al.
Arthritis and the skin
- et al.
Update on rheumatoid arthritis
Practitioner
(1994) - et al.
Autoimmunity and rheumatoid arthritis
Hosp Update
(1995) - et al.
Rheumatoid arthritis. II. Treatment
Br Med J
(1995) - et al.
The effectiveness of early treatment with ‘second line’ anti-rheumatic drugs
Ann Intern Med
(1996)
Cited by (3)
Podiatry, biomechanics and the rheumatology foot
2010, Rheumatology: Evidence-Based Practice for Physiotherapists and Occupational TherapistsLooking through the 'window of opportunity': Is there a new paradigm of podiatry care on the horizon in early rheumatoid arthritis?
2010, Journal of Foot and Ankle Research