Rheumatoid arthritis: Perioperative management of biologics and DMARDs.
OBJECTIVE
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.


METHODS
Published literature regarding arthroplasty in RA has been reviewed and discussed.


RESULTS
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.


CONCLUSIONS
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.
Department of Medicine, Weill Cornell Medical College, New York, NY; Division of Rheumatology, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. Electronic address: GoodmanS@HSS.edu.
Susan M
SM
Goodman
D000069594:Abatacept / Q000627:therapeutic use; D000068879:Adalimumab / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D019643:Arthroplasty, Replacement / Q000379:methods*; D001688:Biological Products / Q000627:therapeutic use*; D000068800:Etanercept / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D019990:Perioperative Care / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D000069283:Rituximab / Q000627:therapeutic use
D018501:Antirheumatic Agents; D001688:Biological Products; D000069283:Rituximab; D006886:Hydroxychloroquine; D000069594:Abatacept; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate
Arthroplasty; Methotrexate; Perioperative management; Prosthetic joint infection; Rheumatoid arthritis; TNFα inhibitors