2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

Goodman, Susan M.; Springer, Bryan D.; Guyatt, Gordon; Abdel, Matthew P.; Dasa, Vinod; George, Michael; Gewurz‐Singer, Ora; Giles, Jon T.; Johnson, Bryce V.; Lee, Stephen; Mandl, Lisa A.; Mont, Michael A.; Sculco, Peter K.; Sporer, Scott M.; Stryker, Louis S.; Turgunbaev, Marat; Brause, Barry D.; Chen, Antonia F.; Gililland, Jeremy M.; Goodman, Mark A.; Hurley-Rosenblatt, Arlene; Kirou, Kyriakos A.; Losina, Elena; MacKenzie, Ronald; Michaud, Kaleb; Mikuls, Ted R.; Russell, Linda; Sah, Alexander P.; Miller, Amy S.; Singh, Jasvinder A.; Yates, Adolph J.

doi:10.1016/j.arth.2017.05.001

Cited by 97 publications

(27 citation statements)

References 81 publications

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“…The American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons recently published Guidelines on the appropriate perioperative timing of treatment discontinuation in rheumatic patients undergoing arthroplasties. 29 Although practical and easy to use, all the included recommendations are conditional.…”

Section: Postoperative Prosthetic Joint Infectionsmentioning

confidence: 99%

Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies

Thomas

Vassilopoulos

2020

MJR

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The third decade of the 21 st century marks the beginning of a new era in the treatment of rheumatoid arthritis (RA). Recently, after the introduction in clinical practice of different biologics in the first decade, three different oral synthetic targeted agents (JAK inhibitors) have been licensed for the treatment of RA, in patients who had failed or are intolerant to disease modifying anti-rheumatic drugs (DMARDs). Despite the significant progress that these agents bring to the care of RA patients, the risk of infections is still present and clear, given that their risk for serious infections is at least comparable with that of biologic DMARDs, whereas the incidence of herpes zoster is higher than that of bDMARDs. Here, we review the most recent data regarding the risk for serious and opportunistic infections in RA patients treated with biologics or JAK inhibitors, as well the up-to-date approach for managing and preventing such infections in RA patients.

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Section: Postoperative Prosthetic Joint Infectionsmentioning

confidence: 99%

Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies

Thomas

Vassilopoulos

2020

MJR

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“… Abbreviations: AAHKS, Association of Hip and Knee Surgeons; AAOS, American Academy of Orthopedic Surgeons; ACR, American College of Rheumatology; ASA, aspirin; CDC, Centers for Disease Control; CHEST, The American College of Chest Physicians; DOAC, direct oral anticoagulant (eg, apixaban, dabigatran, and rivaroxaban); LMWH, low-molecular-weight heparin (eg, enoxaparin); NICE, National Institute for Health and Care Excellence; Ortho, orthopedic operations; SSI, surgical site infection; THA, total hip arthroplasty; TKA, total knee arthroplasty; TNF, tumor necrosis factor; UFH, unfractionated heparin; VKA, vitamin K antagonist (eg, warfarin); WHO, World Health Organization; VTE, venous thromboembolism. a Adapted from American Academy of Orthopedic Surgeons, 9 American College of Rheumatology/American Association of Hip and Knee Surgeons, 10 American College of Surgeons and Surgical Infection Society, 8 Centers for Disease Control and Prevention surgical site infection, 11 CHEST, 12 and National Institute for Health and Care Excellence. 13 b Year includes published date or date guidelines were last updated, whichever is later.…”

Section: Resultsmentioning

confidence: 99%

“… a Adapted from American Academy of Orthopedic Surgeons, 9 American College of Rheumatology/American Association of Hip and Knee Surgeons, 10 American College of Surgeons and Surgical Infection Society, 8 Centers for Disease Control and Prevention surgical site infection, 11 CHEST, 12 and National Institute for Health and Care Excellence. 13 …”

Section: Resultsmentioning

confidence: 99%

“…A collaboration between the American College of Rheumatology (ACR) and the Association of Hip and Knee Surgeons (AAHKS) recently released guidelines on this topic, including a comprehensive assessment of the literature—the majority of which was not specific to orthopedic operations. 10 In brief, for patients with RA, they recommend perioperative continuation of conventional agents and holding biologic agents.…”

Section: Resultsmentioning

confidence: 99%

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Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Childers

Siletz

Singer

et al. 2018

Geriatr Orthop Surg Rehabil

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Background:Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA).Study Design:This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format.Results:Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning.Conclusion:This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.

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“…Biologic agents will be withheld prior to TKA and surgery will be planned at the end of the dosing cycle for that specific medication. The biologic therapy will be restarted when the wound shows evidence of healing without surgical site infections (typically two weeks after TKA) [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of preemptive antifibrinolysis with tranexamic acid in rheumatoid arthritis patients undergoing total knee arthroplasty: a study protocol for a randomized controlled trial

Lei

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: Patients with rheumatoid arthritis (RA) who have undergone total knee arthroplasty are at increased risk of requiring a blood transfusion. This study is designed to compare the effects of preemptive antifibrinolysis of single-dose and repeat-dose tranexamic acid (TXA) in in RA patients undergoing total knee arthroplasty (TKA). Methods/design: The study will be a double-blind randomized controlled trial with two parallel groups of RA patients. Group A will be given 100 ml normal saline twice daily starting from 3 days before the operation, Group B will be given TXA 1.5 g twice daily starting from 3 days before the operation. All patients will be given TXA 1.5 g 30 min before the operation. The primary outcomes will be evaluated with total blood loss and hidden blood loss. Other outcome measurements such as, fibrinolysis parameters, inflammatory factors, visual analogue scale for postoperative pain, analgesia usage, coagulation parameters, transfusion, the length of stay (LOS), total hospitalization costs, the incidence of thromboembolic events and other complications will be recorded and compared. Recruitment is scheduled to begin on 1 August 2020, and the study will continue until 31 May 2021. Discussion: In current literature there is a lack of evidence with regard to the efficacy of TXA in RA patients. The findings of this study, whether positive or negative, will contribute to the formulation of further recommendations on the use of TXA in RA patients undergoing TKA.

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2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

Abstract: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

Cited by 97 publications

References 81 publications

Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies

Infections in Patients with Rheumatoid Arthritis in the Era of Targeted Synthetic Therapies

Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Effectiveness of preemptive antifibrinolysis with tranexamic acid in rheumatoid arthritis patients undergoing total knee arthroplasty: a study protocol for a randomized controlled trial

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