Do antitumor necrosis factor agents increase the risk of postoperative orthopedic infections?
OBJECTIVE
Patients with rheumatoid arthritis and other inflammatory arthritides treated with tumor necrosis factor inhibitors frequently undergo orthopedic procedures. These patients may be at risk for serious postoperative infections as antitumor necrosis factor agents may be associated with impaired immunity against usual and opportunistic pathogens.


RESULTS
Information regarding the influence of tumor necrosis factor inhibitors on the risk for postoperative orthopedic complications is limited, contradictory and solely based on retrospective studies. Basic science derived data seem to only add to the confusion.


CONCLUSIONS
The practitioner is at a loss whenever a decision regarding the perioperative handling of antitumor necrosis factor agents has to be made. An attempt to combine, reconcile, and expand the knowledge available in the current literature will be made.
Pappas
Dimitrios A
DA
Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Giles
Jon T
JT
D018501:Antirheumatic Agents / Q000009:adverse effects*; D001168:Arthritis / Q000188:drug therapy / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000139:chemically induced* / Q000209:etiology; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha