Multidisciplinary Team Led by Joint Surgeons to Rapidly Identify Spondyloarthritis.

Context: Spondyloarthritis (SpA) is a group of chronic, inflammatory, rheumatic diseases of which axial SpA and peripheral SpA are the two main types. Patients that predominantly have manifestations of axSpA may have additional peripheral-arthritis symptoms, and vice versa. For these hard-to-diagnose SpA patients, symptoms can be nonspecific and difficult to identify, making it easy to miss a diagnosis or misdiagnosis patients, resulting in disability. Objective: The study intended to evaluate the value of a multidisciplinary team (MDT) led by the joint surgeons to rapidly identify spondyloarthritis (SpA). Design: The research team designed a controlled study that analyzed the clinical data of patients with spondyloarthritis. Setting: The study was conducted in the Department of Joint Surgery at Shandong Second Provincial General Hospital in Jinan, China. Participants: Participants were 113 SpA patients at the hospital between January 2019 and January 2020. Intervention: he research team divided participants into an intervention group, the MDT group that used that model to diagnose 83 participants and the control group with 30 participants, for whom diagnoses occurred using the conventional diagnostic model. Outcome Measures: The research team collected data on participants' number of visits and number of departments visited as well as determined the amount of time that elapsed before a diagnosis occurred. The team also measured C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and the scores on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI) at baseline and after 3 months and 6 months treatment. Results: In the MDT group, diagnoses included: (1) axial SpA (axSpA)-73 participants, and (2) peripheral SpA-10 participants, including three with reactive arthritis, two with uveitis, and five with psoriatic arthritis. Eight participants in that group were HLA-B27 positive, and 14 had complications from a latent tuberculosis infection. In the control group, diagnoses included: (1) axSpA-25 participants; and (2) peripheral SpA-5 participants, including three with psoriatic arthritis and two with reactive arthritis. Six participants in that group were HLA-B27 positive and four had complications from a latent tuberculosis infection. The number of visits, number of departments visited, and time to diagnosis in the MDT group were significantly lower than those in the control group (P < .001). After three and six months of treatment, the MDT group's CRP, ESR, BASDAI, and BASFI were significantly lower than those at baseline (P < .001). Conclusions: The MDT model of spondyloarthritis led by joint surgeons was accurate and efficient, allowing the medical personnel to quickly identify and intervene in SpA and provide effective treatment for patients. It's a diagnosis and treatment model worthy of promotion.

Need for anti-tuberculosis treatment in patients with latent tuberculosis infection who undergo arthroplasty: a case report.

Background: It is currently estimated that about 1/3 of the global population is infected with mycobacterium tuberculosis (TB), and about 90% of those infected have asymptomatic latent infections. It has been reported that 85-90% of newly diagnosed active TB cases evolve from patients with latent tuberculosis infection (LTBI). In approximately 5-10% of patients, LTBI progresses to active TB during their lifetime. The number of artificial arthroplasty procedures performed is increasing. The vast majority of people undergoing arthroplasty are aged 60 years and older. Aging and surgical trauma can reduce the ability of the body to fight infection, which can also promote the recurrence of old or dormant TB infections. TB has been reported to reoccur in LTBI patients after arthroplasty who do not receive anti-TB treatment. This article reports the case of an elderly female patient with LTBI and knee osteoarthritis who underwent total knee arthroplasty and achieved good clinical results with anti-TB drug treatment. There is a lack of guidelines for the treatment of patients with LTBI undergoing artificial arthroplasty. This article attempts to provide a time-based treatment approach to reduce the recurrence of LTBI based on a literature review. Case Description: Based on a detailed history, a physical examination, and ancillary examinations, this 71-year-old female patient was found to have no active TB; however, after a positive ɣ-interferon release assay (IGRA) for TB infection, she was diagnosed with LTBI. She underwent artificial knee arthroplasty to treat osteoarthritis of the right knee. Anti-TB drugs were administered 2 weeks after the surgery, and good clinical results were achieved at the 53-month post-operative follow-up with no recurrence of TB. Conclusions: Patients with LTBI who undergo artificial arthroplasty require anti-TB treatment to reduce the risk of TB recurrence.