title: From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis.
abstract: Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.
authors.affiliation: Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
authors.forename: Young M
authors.initials: YM
authors.lastname: Choi
authors.affiliation: Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
authors.forename: Maya
authors.initials: M
authors.lastname: Debbaneh
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Weinberg
authors.affiliation: Dermatology Institute and Skin Care Center, Santa Monica, California; Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Yamauchi
authors.affiliation: Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia.
authors.forename: Abby S
authors.initials: AS
authors.lastname: Van Voorhees
authors.affiliation: Department of Dermatology, University of Southern California, Los Angeles, California.
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.affiliation: National Psoriasis Foundation, Portland, Oregon.
authors.forename: Michael
authors.initials: M
authors.lastname: Siegel
authors.affiliation: Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Electronic address: jashinwu@gmail.com.
authors.forename: Jashin J
authors.initials: JJ
authors.lastname: Wu
mesh_terms: D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000494:pharmacology / Q000627:therapeutic use*; D056747:Immunomodulation; D008297:Male; D061214:Patient Safety; D019990:Perioperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D018570:Risk Assessment; D012955:Societies, Medical; D013044:Specialty Boards; D013514:Surgical Procedures, Operative / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors
keywords: biologic; cyclosporine; immunosuppressant; methotrexate; perioperative; psoriasis; psoriatic arthritis; tumor necrosis factor-alfa inhibitor