類風溼性關節炎患者之脊柱骨髓炎臨床表現與治療反應

The Clinical Features and Outcome of Native Vertebral Osteomyelitis in Patients with Rheumatoid Arthritis

Objective: The clinical features and outcomes of native vertebral osteomyelitis (NVO) in patients withrheumatoid arthritis (RA) are unknown. We analyzed the relevant data from a medical center in Taiwan.Methods: We retrospectively reviewed the medical records of patients with RA diagnosed with NVObetween 2006 and 2016 in Taipei Veterans General Hospital, Taiwan. Clinical presentations, laboratoryparameters, and treatment outcomes were analyzed.Results: Twelve eligible patients with 26 NVO episodes were enrolled and separated into groups ofprimary episodes (12) and recurrent episodes (14). The median age of the cohort was 70 years, and 8 (66.7%)were female. Spinal pain was the most common symptom (100%). The lumbar-sacral spine was the mostcommon site of NVO (84.6%), followed by the thoracic spine (19.2%) and cervical spine (7.7%). Themost common organism was methicillin-sensitive Staphylococcus aureus (19.2% of bacteremia), followedby methicillin-resistant S. aureus (7.7% of bacteremia and 7.7% of biopsy specimens). The medianduration of the parenteral antibiotic course was 53 days (interquartile range, 30-67 days). Recurrencedeveloped in 9 patients (75%), and the median time to recurrence after completing treatment was 37 days(interquartile range, 14-418 days). Vertebral osteomyelitis developed in 7 patients (58%) after an invasivespinal procedure, and six patients experienced recurrence.Conclusions: The recurrence of NVO in patients with rheumatoid arthritis is relatively high. Back pain isthe most common presentation and can provide a hint for diagnosis. 目的：探討北部一家醫學中心之類風溼性關節炎病人罹患脊柱骨髓炎的臨床症狀及結果。方法：蒐集2006年1月至2016年12月間，針對類風濕性關節炎合併脊柱骨髓炎的病人，於台北榮民總醫院接受治療之患者。以病例回溯性方式記錄患者臨床表現與治療成效。結果：本研究納入12位類風濕性關節炎病人診斷罹患脊柱骨髓炎，追蹤11年共發生26次脊柱骨髓炎，12位病人中有9位產生復發性的脊柱骨髓炎，復發次數共14次。病人發生脊柱骨髓炎的中位數為70,8（66.7%）位為女性。背痛為最常見之臨床症狀，腰薦部脊椎（84.6%）為最常發生的部位。胸椎（19.2%）與頸椎（7.7%）次之。類風濕性關節炎合併脊柱骨髓炎致病菌中，methicillinsensitive Staphylococcus aureus最為常見（佔百分之19點2的菌血症），次為methicillin-resistant Staphylococcus aureus（佔百分之7點7的菌血症與百分之7點7切片培養陽性）。接受靜脈抗生素療程天數之中位數為53天（四分位距，30至67天）。百分之七十五病人發生復發脊柱骨髓炎，從完成抗生素治療至復發之時間，中位數為37天（四分位距，14至418天）。百分之五十八（七位）病人在接受侵入性脊柱手術後產生脊柱骨髓炎，當中六位病人產生復發性的脊柱骨髓炎。結論：在本研究中，類風濕性關節炎病人罹患脊柱骨髓炎後，有較高比率產生脊柱骨髓炎復發。背痛為最常見的臨床症狀且為診斷脊柱骨髓炎的指標。