[2007] [SAT0345] USE OF ANTI-TNF AGENTS IN 15 RHEUMATOID ARTHRITIS PATIENTS UNDERGOING TOTAL ELBOW ARTHROPLASTY

D.G. Arkfeld ¹, S. Kasraeian ², S. Metyas ¹, J. Itomura ^{2 1}Rheumatology, ²Orthopedics, University of Southern California, Los Angeles, United States

Background: Advanced rheumatoid arthritis patients suffer from joint destruction often necessitating the use of aggressive therapy such as biological agents and joint arthroplasty procedures. Involvement of the elbow, although less common than hip or knee joint, often leads to total elbow arthroplasty to preserve upper extremity function. The use of anti-TNF agents in this surgical population is assessed in this abstract.
Objectives: In this retrospective study, we explored the risks and benefits of rheumatoid arthritis patients undergoing total elbow arthroplasty procedure.
Methods: 15 RA patients underwent 22 total elbow arthroplasties including 5 revision arthroplasties by a single orthopedic specialist at an academic institution in Los Angeles California. Average followup for both groups was 7.9 months(range 0.25 to 24 months). 11 elbows were exposed to an anti-TNF agents and 11 elbows were not exposed to these agents.
Results: Infections associated with the elbow arthroplasties occurred in 4/11(36%) patients exposed to anti-TNF agents compared to 1/11(9%) patients who were not exposed to anti-TNF agents.
3 revisions in anti-TNF group and 1 revision in non-anti-TNF group were performed due to infection. 1 revision in anti-TNF group was performed due to a mechanical reason.
Conclusion: An apparent increased risk of infection occurred in RA patients undergoing total elbow arthroplasty procedures that were exposed to anti-TNF agents. The elbow location may pose an increased risk due to both it's proximity to the dermis and complexity of the surgery. An additional observation is that the elbow replacements were necessary in this group of patients in an attempt to maintain adequate upper extremity function. Further investigation into the risks and benefits of total elbow arthroplasties in RA is indicated.

Infection-related rheumatic diseases