Infectious risk associated to orthopaedic surgery for rheumatoid arthritis patients treated by anti-TNFalpha.
BACKGROUND
Although biotherapy has greatly improved the prognosis of RA many patients have still recourse to an orthopaedic surgery. The current recommendation for scheduled surgery is to discontinue administration of the biological agent two to six weeks before surgery. Reinitiating anti-TNF therapy is proposed when the patient has healed. We wanted to know whether patients treated with anti-TNFα were exposed to an infectious risk undergoing a surgical procedure and if discontinuation of anti-TNFα therapy altered the risk of surgical infection.


METHODS
We conducted a systematic review of the literature in PubMed, Embase and Cochrane until March 2014. We selected studies that reported post-operative infections by comparing patients treated with anti-TNFα to patients treated with csDMARD without biological treatment, or patients who continued anti-TNFα therapy to the patients who discontinued treatment prior to surgery.


RESULTS
A first meta-analysis of 12 studies evaluating postoperative infection risk in patients treated with anti-TNFα showed that the postoperative infection risk doubled (RR=1.81 [1.31-2.50]). Seven studies were grouped into a second meta-analysis to evaluate the benefit of the preventive discontinuation of anti-TNFα. Discontinuation of treatment did not alter the post-operative infection risk significantly: RR=0.69 [0.39-1.21].


CONCLUSIONS
This study showed that patients treated with anti-TNFα were more at risk of post-operative infection undergoing orthopaedic surgery. Preventive discontinuation of anti-TNFα does not seem to change this risk.
Centre de Rhumatologie, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 31000 Toulouse, France.
Charlotte
C
Mabille
Centre de Rhumatologie, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 31000 Toulouse, France.
Yannick
Y
Degboe
Centre de Rhumatologie, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 31000 Toulouse, France.
Arnaud
A
Constantin
Service de Rhumatologie, Hôpital Pellegrin, CHU Bordeaux, 33000 Bordeaux, France.
Thomas
T
Barnetche
Centre de Rhumatologie, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 31000 Toulouse, France.
Alain
A
Cantagrel
Centre de Rhumatologie, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 31000 Toulouse, France. Electronic address: Ruyssen-witrand.a@chu-toulouse.fr.
Adeline
A
Ruyssen-Witrand
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007239:Infections / Q000209:etiology*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha
Anti-TNFα; Infection; Rheumatoid arthritis; Surgery