INFLUENCE OF MEDICATION ON FLARE UP AND INFECTION AFTER ELECTIVE ORTHOPEDIC SURGERY IN RHEUMATOID ARTHRITIS PATIENT - A NARRATIVE REVIEW

Yaldi Rosadi, Yustin Marinta, Muthiah Nur Afifah

= http://dx.doi.org/10.20473/joints.v9i2.2020.77-89
Abstract views = 691 times | downloads = 486 times

Abstract


Background: Orthopedic Surgery in Rheumatoid Arthritis (RA) patients is still controversial between orthopedic surgeons and rheumatologists, mainly due to infection and disease flares. The incidence of postoperative infections may be high due to the immunosuppressive effect of RA medication. Conversely, discontinuance of antirheumatic agents increases the possibility of a disease flare. The objective of our review is to assess the influence of drugs on both incidences.

Literature Review: There were 13 studies included in this review. Methotrexate (MTX) is the most common csDMARD option among the included studies. One retrospective study that the incidence of flares tends to be higher among the group of patients who received MTX therapy and stopped more than one week before surgery than the group who did not stop. The use of MTX doses of 5 to 10 mg/week did not show an association with infection or flare incidence. On the use of bDMARD, 37.0% of patients had higher surgical site infection (SSI). Specifically, Tumor Necrosis Factor-alpha (TNF-α) inhibitors significantly (OR: 9.5, 95% CI: 1.0-88.8) increase the incidence of postoperative infections in standard-dose and high-dose, but not significantly in the rate of flares.

Summary: csDMARD is recommended for continuous therapy, whereas for bDMARD, although it is recommended for withholding in the perioperative period, the results of the study did not show significant differences. The ideal dosage of medication is by the basic properties of the drug. In comparison, the incidence of flares and infections was significantly higher in biologic than csDMARD.


Keywords


Arthroplasty; DMARD; Flare-up; Infection; Rheumatoid arthritis

Full Text:

PDF

References


Tateiwa D, Yoshikawa H, Kaito T. Cartilage and Bone Destruction in Arthritis: Pathogenesis and Treatment Strategy: A Literature Review. Cells. 2019;8(8).

Young BL, Watson SL, Perez JL, McGwin G, Singh JA, Ponce BA. Trends in joint replacement surgery in patients with rheumatoid arthritis. J Rheumatol. 2018;45(2):158–64.

LoVerde ZJ, Mandl LA, Johnson BK, Figgie MP, Boettner F, Lee YY, et al. Rheumatoid arthritis does not increase risk of short-term adverse events after total knee arthroplasty: A retrospective case-control study. J Rheumatol. 2015;42(7):1123–30.

Cordtz RL, Zobbe K, Højgaard P, Kristensen LE, Overgaard S, Odgaard A, et al. Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: A nationwide cohort study using Danish healthcare registers. Ann Rheum Dis. 2018;77(2):281–8.

Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Rheumatol. 2017;69(8):1538–51.

Gualtierotti R, Parisi M, Ingegnoli F. Perioperative management of patients with inflammatory rheumatic diseases undergoing major orthopaedic surgery: A practical overview. Adv Ther. 2018;35(4):439–56.

Momohara S, Kawakami K, Iwamoto T, Yano K, Sakuma Y, Hiroshima R, et al. Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. Mod Rheumatol. 2011;21(5):469–75.

Baker JF, George MD. Prevention of Infection in the Perioperative Setting in Patients with Rheumatic Disease Treated with Immunosuppression. Curr Rheumatol Rep. 2019;21(5).

Goodman SM. Rheumatoid arthritis: Perioperative management of biologics and DMARDs. Semin Arthritis Rheum. 2015;44(6):627–32.

Murata K, Yasuda T, Ito H, Yoshida M, Shimizu M, Nakamura T. Lack of increase in postoperative complications with low-dose methotrexate therapy in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Mod Rheumatol. 2006;16(1):14–9.

Goodman SM, Paget S. Perioperative Drug Safety in Patients with Rheumatoid Arthritis. Rheum Dis Clin North Am. 2012;38(4):747–59.

Grennan DM, Gray J, Loudon J, Fear S. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis. 2001;60(3):214–7.

Jain A, Witbreuk M, Ball C, Nanchahal J. Influence of steroids and methotrexate on wound complications after elective rheumatoid hand and wrist surgery. J Hand Surg Am. 2002;27(3):449–55.

Yamada S, Kumagai K, Harigane K, Choe H, Tezuka T, Mochida Y, et al. Factors associated with disease activity after orthopaedic surgery in patients with rheumatoid arthritis. Mod Rheumatol. 2019;0(0):000.

Wolfe J, Wolfe J, Visser HJ. Perioperative Management of the Rheumatoid Patient. Clin Podiatr Med Surg. 2019;36(1):115–30.

Johnson BK, Goodman SM, Alexiades MM, Figgie MP, Demmer RT, Mandl LA. Patterns and associated risk of perioperative use of anti-tumor necrosis factor in patients with rheumatoid arthritis undergoing total knee replacement. J Rheumatol. 2013;40(5):617–23.

Hayashi S, Hashimoto S, Takayama K, Matsumoto T, Takebe K, Terashima Y, et al. Risk factors for late deep infection after total hip arthroplasty in patients with rheumatoid arthritis. Acta Reumatol Port. 2017;42(2):150–4.

Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;685–99.

Jin J, Chang Y, Wei W. Clinical application and evaluation of anti-TNF-Α -alpha agents for the treatment of rheumatoid arthritis. Acta Pharmacol Sin. 2010;31(9):1133–40.

Kubota A, Nakamura T, Miyazaki Y, Sekiguchi M, Suguro T. Perioperative complications in elective surgery in patients with rheumatoid arthritis treated with biologics. Mod Rheumatol. 2012;22(6):844–8.

Goodman SM, Bykerk VP, DiCarlo E, Cummings RW, Donlin LT, Orange DE, et al. Flares in patients with rheumatoid arthritis after total hip and total knee arthroplasty: Rates, characteristics, and risk factors. J Rheumatol. 2018;45(5):604–11.

Yano K, Ikari K, Inoue E, Tokita A, Sakuma Y, Hiroshima R, et al. Effect of total knee arthroplasty on disease activity in patients with established rheumatoid arthritis: 3-year follow-up results of combined medical therapy and surgical intervention. Mod Rheumatol. 2010;20(5):452–7.

Kawakami K, Ikari K, Kawamura K, Tsukahara S, Iwamoto T, Yano K, et al. Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-α blockers: Perioperative interruption of tumour necrosis factor-a blockers decreases complications? Rheumatology.2010;49(2):341–7.

Compagnoni R, Gualtierotti R, Randelli P. Total Joint Arthroplasty in Patients with Inflammatory Rheumatic Diseases. Adv Ther. 2018;35(8):1133–9.

P. N, D. N. Perceptions of methotrexate use in rheumatoid arthritis by rheumatologists and their patients: AN Australian survey study. Int J Rheum Dis. 2013;16(6):652–61.


Refbacks



Copyright (c) 2020 JOINTS (Journal Orthopaedi and Traumatology Surabaya)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

JOINTS is indexed by:

          

 

JOINTS (Journal Orthopaedi and Traumatology Surabaya) (e-ISSN: 2460-8742, p-ISSN: 2722-712X) is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

 

 

View My Stats