title: Should anti-TNF therapy be discontinued in rheumatoid arthritis patients undergoing elective orthopaedic surgery? A systematic review of the evidence.
abstract: Anti-tumour necrosis factor (TNF) therapies have revolutionized the management of rheumatoid arthritis (RA). A high proportion of RA patients are now established users of anti-TNF agents. Unfortunately, many RA patients with longstanding disease still require elective orthopaedic procedures. Published studies on the influence of TNF antagonist on infection rates in RA patients undergoing surgery are conflicting. However, national registries of RA patients on anti-TNF reported an increased risk of infection. The risk of anti-TNF-related infection is highest at the start of treatment with frequent involvement of the skin and subcutaneous tissue. Infection at these sites could negatively influence the healing of surgical wound. Current guidelines suggest that treatment with biologics should be discontinued prior to surgery. Patients with established disease are more likely to flare compared to those with early disease on stopping treatment. Consequently, TNF blockers need to be reinstated promptly after surgery to avoid the risk of RA flare.
authors.affiliation: Department of Rheumatology, Musgrove Park Hospital, Taunton, Somerset, TA1 5DA, UK. Lesliegohs2000@yahoo.com
authors.forename: Leslie
authors.initials: L
authors.lastname: Goh
authors.forename: Teresa
authors.initials: T
authors.lastname: Jewell
authors.forename: Catherine
authors.initials: C
authors.lastname: Laversuch
authors.forename: Ash
authors.initials: A
authors.lastname: Samanta
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000601:surgery*; D000075202:Contraindications; D017558:Elective Surgical Procedures; D006801:Humans; D019637:Orthopedic Procedures; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D028761:Withholding Treatment
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha