Rheumatoid arthritis: Perioperative management of biologics and DMARDs

Seminars in Arthritis and Rheumatism
Susan M Goodman

Abstract

Arthroplasty remains prevalent for patients with rheumatoid arthritis (RA), but outcomes are not equivalent to patients with osteoarthritis, and complications including infection are increased. The objective of this article is to review the current evidence supporting perioperative medication management. Challenges are discussed such as continuing potent disease-modifying therapy (DMARDs) and biologics, which may increase infection risk, versus withholding these medications, which may result in disease flares. Published literature regarding arthroplasty in RA has been reviewed and discussed. Some DMARDs such as methotrexate and hydroxychloroquine appear safe in the perioperative period. Anti-TNFα biologics should be withheld due to increase in infection risk, while the impact of rituximab and abatacept on infection risk has not been as clearly defined. This article provides an overview of arthroplasty in RA, summarizes the evidence supporting perioperative medication management including corticosteroids, and identifies areas where further study is needed.

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Citations

Dec 25, 2015·Best Practice & Research. Clinical Rheumatology·Susan M Goodman, Mark A Figgie
Sep 10, 2015·International Journal of Rheumatology·John L GillickKaushik Das
Oct 25, 2016·Regional Anesthesia and Pain Medicine·Daltry DottAndrew Brian Thomson
May 23, 2017·Orthopedics·Kunal SindhuJoseph A Gil
Jan 28, 2017·Arthritis Care & Research·Michael D GeorgeJeffrey R Curtis
Nov 16, 2018·The Journal of Dermatological Treatment·Kerasia-Maria Plachouri, Sophia Georgiou
Nov 18, 2018·Expert Opinion on Drug Safety·Laurence DuquennePaul Emery
May 20, 2016·Anesthesia and Analgesia·Gareth L Ackland, Robert C M Stephens
Feb 12, 2019·Arthritis Care & Research·Michael D GeorgeJeffrey R Curtis
Jan 10, 2020·Journal of Orthopaedic Surgery·Suroosh MadanipourAbbas Rashid
Dec 23, 2016·Current Molecular Biology Reports·Hilal Maradit KremersDavid G Lewallen
May 26, 2017·Clinical Rheumatology·Julio J JaureguiS Ashfaq Hasan
Nov 10, 2018·Clinical Rheumatology·Richard SetoRichard S Panush
Feb 6, 2021·The Spine Journal : Official Journal of the North American Spine Society·Michael A GaudianiDaniel J Coughlin
Apr 20, 2021·Advanced Healthcare Materials·Long ChenHai-Quan Mao
Sep 4, 2021·The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation·Maria M CrespoAllan R Glanville

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