Szeptikus infekció rheumatoid arthritisben

Translated title of the contribution: Lethal septic infection in rheumatoid arthritis

M. Bély, Apáthy Ágnes

Research output: Contribution to journalArticle

Abstract

INTRODUCTION - The lethal septic infection was studied in a randomized (non-selected) autopsy population of 234 in-patients with rheumatoid arthritis. The patients died at the National Institute of Rheumatology between 1970 and 1999. PATIENTS AND METHOD - The aims of this study were to determine the prevalence of lethal septic infection with or without purulent arthritis in rheumatoid arthritis; the relationship between purulent arthritis and lethal septic infection; the clinically missed diagnosis of lethal septic infection and purulent arthritis; the influence of the main complications and associated diseases on lethal septic infection with and without purulent arthritis; the pathogens in lethal septic infection; and the clinico-laboratory parameters associated with lethal septic infection in rheumatoid arthritis. RESULTS - Lethal septic infection was found in 31 (13.24%) of 234 rheumatoid arthritis patients. Purulent arthritis complicated lethal septic infection in 15 (6.4%) of 31 patients. There was a significant association between lethal septic infection and purulent arthritis. Sepsis was detected clinically in 17 of 31 lethal cases and purulent arthritis was detected 9 of 15 septic infection complicated with suppurative articular processes. The coexistent complications (systemic vasculitis, AA amyloidosis), and associated diseases (tuberculosis with or without miliary dissemination, malignant tumors, diabetes mellitus) did not influence the prevalence of septic infection. The most frequent pathogenic agents were: Staphylococcus aureus, Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella species, Streptococcus species. The patients with septic infection had significantly lower levels of beta-globulin, and higher values of Waaler-Rose or latex fixation test in comparison to patients without septic infection or without complications. CONCLUSION - Lethal septic infection may exist in rheumatoid arthritis without the classical clinical symptoms of sepsis, and clinically latent suppurative processes may be found at autopsy. The missed clinical diagnosis of a fatal complication is explained by the weak immune response and atypical clinical symptoms of elderly patients mainly treated with steroids and immunosuppressive drugs.

Original languageHungarian
Pages (from-to)857-866
Number of pages10
JournalLege Artis Medicinae
Volume14
Issue number12
Publication statusPublished - 2004

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Rheumatoid Arthritis
Infection
Arthritis
Autopsy
Sepsis
Beta-Globulins
Latex Fixation Tests
Systemic Vasculitis
Proteus mirabilis
Infectious Arthritis
Klebsiella
Rheumatology
Amyloidosis
Immunosuppressive Agents
Streptococcus
Pseudomonas aeruginosa
Staphylococcus aureus
Diabetes Mellitus
Tuberculosis
Joints

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Szeptikus infekció rheumatoid arthritisben. / Bély, M.; Ágnes, Apáthy.

In: Lege Artis Medicinae, Vol. 14, No. 12, 2004, p. 857-866.

Research output: Contribution to journalArticle

Bély, M & Ágnes, A 2004, 'Szeptikus infekció rheumatoid arthritisben', Lege Artis Medicinae, vol. 14, no. 12, pp. 857-866.
Bély, M. ; Ágnes, Apáthy. / Szeptikus infekció rheumatoid arthritisben. In: Lege Artis Medicinae. 2004 ; Vol. 14, No. 12. pp. 857-866.
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abstract = "INTRODUCTION - The lethal septic infection was studied in a randomized (non-selected) autopsy population of 234 in-patients with rheumatoid arthritis. The patients died at the National Institute of Rheumatology between 1970 and 1999. PATIENTS AND METHOD - The aims of this study were to determine the prevalence of lethal septic infection with or without purulent arthritis in rheumatoid arthritis; the relationship between purulent arthritis and lethal septic infection; the clinically missed diagnosis of lethal septic infection and purulent arthritis; the influence of the main complications and associated diseases on lethal septic infection with and without purulent arthritis; the pathogens in lethal septic infection; and the clinico-laboratory parameters associated with lethal septic infection in rheumatoid arthritis. RESULTS - Lethal septic infection was found in 31 (13.24{\%}) of 234 rheumatoid arthritis patients. Purulent arthritis complicated lethal septic infection in 15 (6.4{\%}) of 31 patients. There was a significant association between lethal septic infection and purulent arthritis. Sepsis was detected clinically in 17 of 31 lethal cases and purulent arthritis was detected 9 of 15 septic infection complicated with suppurative articular processes. The coexistent complications (systemic vasculitis, AA amyloidosis), and associated diseases (tuberculosis with or without miliary dissemination, malignant tumors, diabetes mellitus) did not influence the prevalence of septic infection. The most frequent pathogenic agents were: Staphylococcus aureus, Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella species, Streptococcus species. The patients with septic infection had significantly lower levels of beta-globulin, and higher values of Waaler-Rose or latex fixation test in comparison to patients without septic infection or without complications. CONCLUSION - Lethal septic infection may exist in rheumatoid arthritis without the classical clinical symptoms of sepsis, and clinically latent suppurative processes may be found at autopsy. The missed clinical diagnosis of a fatal complication is explained by the weak immune response and atypical clinical symptoms of elderly patients mainly treated with steroids and immunosuppressive drugs.",
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