Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-alpha blockers: perioperative interruption of tumour necrosis factor-alpha blockers decreases complications?
OBJECTIVE
TNF-alpha blockers reportedly increase the risk of complications in rheumatic patients following surgery. Whereas deep venous thrombosis (DVT) is a significant complication after orthopaedic surgery of the lower limbs, the risk for DVT in RA patients receiving TNF blockers remains unclear. The aim of this study was to identify complications that can be attributed to the use of TNF-alpha blocker therapy.


METHODS
In a retrospective 1:1 pair-matched case-control study, 64 anti-TNF-treated RA surgeries (TNF group) and 64 surgeries treated with conventional DMARDs (DMARDS group) were evaluated for surgical site infection (SSI), DVT and recurrence of arthritis (flare-up). Multivariate logistic regression analysis was performed to test the association of SSI or DVT with the putative risk factors.


RESULTS
Regression analysis identified the use of TNF blockers as a risk factor for SSI [P = 0.036; odds ratio (OR) = 21.80] and development of DVT (P = 0.03; OR = 2.83) after major orthopaedic surgery: 12.5% (8/64) of the patients in the TNF group had SSI, whereas 2% (1/64) of those in the DMARDs group had SSI. Fifty-one per cent (23/45) of the TNF group, but only 26% (12/45) of the DMARDs group was DVT positive. Flare-ups during the perioperative period were found in 17.2% (11/64) of all patients, and no delay in wound healing occurred in either group.


CONCLUSIONS
These data suggest that the use of TNF blockers is a likely cause of SSI and DVT development in RA patients following major orthopaedic surgery.
Kawakami
Kosei
K
Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
Ikari
Katsunori
K
Kawamura
Koichiro
K
Tsukahara
So
S
Iwamoto
Takuji
T
Yano
Koichiro
K
Sakuma
Yu
Y
Tokita
Asami
A
Momohara
Shigeki
S
D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000139:chemically induced; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications; D012008:Recurrence; D013530:Surgical Wound Infection; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D020246:Venous Thrombosis / Q000139:chemically induced
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha