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  • Case Study
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Implant-related inflammatory arthritis

Abstract

Background A 54-year-old woman presented with myalgia and arthralgia predominantly in the knees and small joints of the hands and feet with morning stiffness lasting for at least 2 h. The patient had received a wrought titanium 6-aluminium 4-vanadium alloy C cage implant 1.5 years previously, following a severe disc prolapse. No signs of rheumatic disease were evident before the C cage was implanted.

Investigations Physical examination, radiography, skin and muscle biopsies, serology tests, white blood cell count, HLA genotyping, tumor necrosis factor release assay, skin patch test, lymphocyte transformation test.

Diagnosis Implant-related inflammatory arthritis.

Management Combination therapy with corticosteroids, disease-modifying antirheumatic drugs and nonsteroidal anti-inflammatory drugs, and replacement of the titanium cage with a polyetherketone cage.

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Figure 1: Skin and muscle biopsy.
Figure 2: Tumor necrosis factor production after incubation of the patient's peripheral blood mononuclear cells with and without different concentrations of titanium dioxide, compared to controls.

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Correspondence to Thomas Dörner.

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The authors declare no competing financial interests.

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Dörner, T., Haas, J., Loddenkemper, C. et al. Implant-related inflammatory arthritis. Nat Rev Rheumatol 2, 53–56 (2006). https://doi.org/10.1038/ncprheum0087

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  • DOI: https://doi.org/10.1038/ncprheum0087

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