allopurinol and Osteoarthritis--Knee

Inconclusive findings about infection risks, importantly the use of immunosuppressive medications in patients who have undergone large-joint total joint arthroplasty, challenge efforts to provide evidence-based perioperative total joint arthroplasty recommendations to improve surgical outcomes. Thus, the aim of this study was to describe risk factors for developing a post-operative infection in patients undergoing TJA of a large joint (total hip arthroplasty, total knee arthroplasty, or total shoulder arthroplasty) by identifying clinical and demographic factors, including the use of high-risk medications (i.e., prednisone and immunosuppressive medications) and diagnoses [i.e., rheumatoid arthritis (RA), osteoarthritis (OA), gout, obesity, and diabetes mellitus] that are linked to infection status, controlling for length of follow-up.. A retrospective, case-control study (N = 2212) using de-identified patient health claims information from a commercially insured, U.S. dataset representing 15 million patients annually (from January 1, 2007 to December 31, 2009) was conducted. Descriptive statistics, t-test, chi-square test, Fisher's exact test, and multivariate logistic regression were used.. Male gender (OR = 1.42, p < 0.001), diagnosis of RA (OR = 1.47, p = 0.031), diabetes mellitus (OR = 1.38, p = 0.001), obesity (OR = 1.66, p < 0.001) or gout (OR = 1.95, p = 0.001), and a prescription for prednisone (OR = 1.59, p < 0.001) predicted a post-operative infection following total joint arthroplasty. Persons with post-operative joint infections were significantly more likely to be prescribed allopurinol (p = 0.002) and colchicine (p = 0.006); no significant difference was found for the use of specific disease-modifying anti-rheumatic drugs and TNF-α inhibitors.. High-risk, post-operative joint infection groups were identified allowing for precautionary clinical measures to be taken.

Topics: Aged; Allopurinol; Arthritis, Rheumatoid; Arthroplasty, Replacement; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Arthroplasty, Replacement, Shoulder; Case-Control Studies; Comorbidity; Diabetes Mellitus; Female; Glucocorticoids; Gout; Gout Suppressants; HIV Infections; Humans; Immunologic Deficiency Syndromes; Immunosuppressive Agents; Logistic Models; Lupus Erythematosus, Systemic; Male; Middle Aged; Multivariate Analysis; Neoplasms; Obesity; Osteoarthritis; Osteoarthritis, Hip; Osteoarthritis, Knee; Prednisone; Prosthesis-Related Infections; Retrospective Studies; Risk Factors; Sex Factors; Shoulder Joint; Surgical Wound Infection

Osteoarthritis is characterized by the presence of proinflammatory cytokines and reactive oxygen species. We aimed to clarify the role of prooxidant enzyme content at the synovial membrane level and how it correlates with the inflammatory process in patients with knee osteoarthritis (KOA). In synovial membranes from KOA patients and control group, we analyzed the protein content of prooxidant enzymes such as Nox2, xanthine oxidase (XO), and prolidase as well as the proinflammatory NALP3. Results show that protein content of prolidase and Nox2 increased 4.8- and 8.4-fold, respectively, and XO showed an increasing trend, while the NALP3 inflammasome increased 5.4-fold with respect to control group. Levels of prolidase and XO had a positive correlation between the levels of NALP3 and Nox2. By principal component analysis the protein expression pattern by study groups was evaluated. Three clusters were identified; protein expression patterns were higher for clusters two (prolidase) and three (XO and Nox2) between KOA patients and controls. Data suggest that prooxidant enzymes increase in synovial membrane of KOA patients and may contribute to the inflammatory state and degradation of the articular cartilage.

Topics: Adult; Aged; Body Mass Index; Case-Control Studies; Cluster Analysis; Cytokines; Dipeptidases; Female; Humans; Inflammasomes; Linear Models; Male; Membrane Glycoproteins; Middle Aged; NADPH Oxidase 2; NADPH Oxidases; NLR Family, Pyrin Domain-Containing 3 Protein; Osteoarthritis, Knee; Principal Component Analysis; Reactive Oxygen Species; Synovial Membrane; Up-Regulation; Xanthine Oxidase

While acute trauma is a major cause of osteoarthritis, its etiology is poorly understood. We sought to determine whether xanthine oxidase (XO), a major producer of reactive oxygen species, plays a role in the early events of acute joint injury.. We analyzed synovial fluid from 23 subjects with recent severe acute knee injury. As a control we evaluated SF from 23 individuals with no or minimal knee osteoarthritis. We measured XO activity, reactive oxygen+reactive nitrogen species (ROS+RNS), protein oxidative damage (carbonyl), the type II collagen synthesis marker procollagen II c-propeptide (CPII) and the type II collagen degradation marker collagen type II telopeptide (CTx-II). We also measured the proinflammatory cytokine IL-6.. XO and ROS+RNS were higher (p=0.02 and p=0.001 respectively) in acute injury than control and were strongly positively associated (r=0.62, p=0.004). Carbonyl was higher in acute injury than control (p=0.0002) and was positively correlated with XO (r=0.68, p=0.0007) as well as with ROS+RNS (r=0.71, p=0.004). CPII was higher in acute injury than control (p<0.0001) and was negatively correlated with XO (r=-0.49, p=0.017). While CTxII was not significantly higher in acute injury than control, it was positively correlated with CPII (r=0.71, p=0.0002). IL-6 was higher in acute injury than control (p<0.0001).. These results are consistent with a potentially injurious effect of XO activity in acute joint injury characterized by excess free radical production and oxidative damage. These effects are associated with an inhibition of type II collagen production that may impede the ability of the injured joint to repair.

Topics: Adult; Aged; Aged, 80 and over; Collagen Type II; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Reactive Nitrogen Species; Reactive Oxygen Species; Synovial Fluid; Xanthine Oxidase; Young Adult

Symptomatic gout in an artificial joint is exceptionally rare. We present a 68-year-old male patient who developed progressive knee pain and swelling one year after the cemented total arthroplasty of his left knee. The diagnosis was confirmed by crystal identification in the synovial fluid. Beside thorough workout to rule out infection in a painful and inflamed prosthetic knee, specific history of gout should be sought and fluid aspirate examined cytologically and under polarised light for crystal arthropathy.

Topics: Acute Disease; Aged; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Arthroplasty, Replacement, Knee; Diagnosis, Differential; Drug Therapy, Combination; Etoricoxib; Follow-Up Studies; Gout Suppressants; Humans; Male; Osteoarthritis, Knee; Postoperative Complications; Pyridines; Sulfones