Authors: Adam M. Smith, M.D., John W. Sperling, M.D., Robert H. Cofield, M.D.
Title: Operative Treatment Of Shoulder Sepsis In Patients With Rheumatoid Arthritis
Addresses: Mayo Clinic, 200 First Street SW, Rochester, MN 55905
Purpose: Currently, there is little information available concerning the results of surgery for sepsis of the native shoulder in patients with rheumatoid arthritis. Therefore, we reviewed our experience with the operative treatment of shoulder sepsis in patients with rheumatoid arthritis
Methods: A retrospective review from 1982 to 2002 of twenty shoulders in seventeen patients with rheumatoid arthritis who underwent surgical intervention for native shoulder sepsis was performed. Twelve were associated with multiple joint infection, five of which were associated with prosthetic hip or knee infection. All patients demonstrated gross signs of infection at surgical intervention with seventeen shoulders having positive cultures (fifteen with Staph aureus). Ten patients were identified to have immune compromising diseases not related to rheumatoid arthritis including diabetes, end-stage renal failure, cancer, COPD, lupus, hepatitis and asplenia.
Results: Three patients died during initial admission to the hospital (at seven days, five months, and six months) due to multi-system organ failure and multiple joint infection. Of the fifteen shoulders in fourteen patients who survived for postoperative examination, there were two excellent, six satisfactory, and seven unsatisfactory results. Mean active elevation was 100 degrees. Further surgery was required in three patients, one requiring synovectomy for chronic pain and effusion and two requiring shoulder arthrodesis due to massive cuff tearing.
Discussion: Patients with rheumatoid arthritis with sepsis of the native shoulder were found to have a high rate of multi-joint sepsis and mortality. Functional outcome in this patient population was likely compromised by the infectious process and preexisting shoulder pathology.
Significance: The presence of immune compromising conditions and chemotherapy places these patients at risk for multi-joint sepsis. A diagnosis of a joint infection in a patient with rheumatoid arthritis should lead the examiners to search for other sources of infection.