Influence of steroids and methotrexate on wound complications after elective rheumatoid hand and wrist surgery

Jain, Abhilash; Witbreuk, M.M.E.H.; Ball, Cathy; Nanchahal, Jagdeep

doi:10.1053/jhsu.2002.32958

Cited by 104 publications

(42 citation statements)

References 24 publications

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“…As such, we reported results similar to those reported by Sherrer et al (22). Finally, our population had particular characteristics that included a high prevalence of comorbid conditions, RF-positivity and middle-to-low socioeconomic status, all of which are known to negatively impact outcomes (10,17,19,22,23). A longer disease duration at surgery also emerged as a risk factor for AOs, and the disease duration cut-off to predict AOs was 20 years.…”

Section: Discussionsupporting

confidence: 82%

“…Few have specifically investigated hand surgery (15,(17)(18)(19)(20)(21)(22), and most have focused on infections and wound dehiscence, which have been detected in up to 10% of patients. Jain et al (17) documented all wound complications after elective hand surgery in 80 RA patients. Immunosuppressive therapy, particularly methotrexate and steroids, were not found to increase risk.…”

Section: Discussionmentioning

confidence: 99%

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Adverse outcomes following hand surgery in patients with rheumatoid arthritis

et al. 2016

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R heumatoid arthritis (RA) is a systemic inflammatory and autoimmune disease characterized by inflammation in the synovial joints. It typically causes a symmetrical small-joint polyarthropathy that affects the proximal interphalangeal and metacarpophalangeal joints of the hands, wrists and feet (1). The wrist joint is often involved early in the disease course, and is regarded as one of the primary therapeutic targets because appropriate treatment prevents patient disability at work and preserves independent self-care (2). Currently, there is good evidence that early recognition of the disease and intensive treatment using disease-modifying antirheumatic drugs (DMARDs) favours improved outcomes and delays disability in RA patients (3). Nevertheless, when synovial inflammation persists over the follow-up period, joint destruction appears early and leads to rheumatic hand disease, which is characterized by deformity, dysfunction and, frequently, pain (4). Patient responses to DMARDs may be highly variable and it is currently exceedingly difficult to predict which patients will respond to which medication regimen, although current research to identify patient-specific disease signatures via genetic and proteomic approaches is ongoing. Functional and aesthetic compromise, and symptomatic complaints are the most common manifestations of the rheumatoid hand and may affect up to 70% of patients with longstanding disease (5). In such a clinical context, indications for surgery, in order of priority are: impending tendon rupture or severe nerve compression, pain relief, improved function and to correct deformity (5). Although there are clear recommendations from the National Institute for Health and Clinical Excellence (NICE) regarding early surgical referral (6), the systemic, progressive and polyarticular nature of RA elevates the complexity involved in decision-making to higher levels than is found in other areas of hand surgery. The definition of successful surgical intervention according to rheumatologists and hand surgeons varies, and has been a matter of debate for generations of physicians (7-9). Generally, rheumatologists underestimate the benefits of HSPs, while the converse is true for hand surgeons. Moreover, VM Menchaca-Tapia, EM Rodríguez, I Contreras-Yáñez, M Iglesias-Morales, V Pascual-Ramos. Adverse outcomes following hand surgery in patients with rheumatoid arthritis.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Adverse outcomes following hand surgery in patients with rheumatoid arthritis

et al. 2016

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“…The majority of data regarding the perioperative safety of methotrexate are from retrospective cohort studies. Five retrospective cohort studies did not demonstrate any difference in perioperative infection or wound complications between those who continued or discontinued methotrexate in the perioperative period [25][26][27][28][29] . In a retrospective evaluation of total joint replacements, 60 patients who had received methotrexate within 4 wk of surgery compared to 61 not receiving methotrexate, there was no difference in postoperative complications including infection or wound healing effects.…”

Section: Traditional Nonbiologic Disease Modifying Antirheumatic Drugsmentioning

confidence: 99%

Perioperative management of the patient with rheumatoid arthritis

Krause¹

2014

WJO

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“…Обращает на себя внимание, что у больных, не получавших БПВП, активность РА через 12 мес наблюдения также была выше (как по среднему значению DAS 28, так и по числу больных с высокой степенью активности). Не выявлено статистически значимых различий по частоте инфекционных ослож-нений у больных, прерывавших прием БПВП в перио-перационном периоде и принимавших эти препараты без перерыва, что согласуется с данными других авто-ров [14][15][16][17][18][19][20][21]23].…”

Section: результаты и обсуждениеunclassified

“…[13] отметили увеличение частоты инфекционных осложнений в послеоперацион-ном периоде в случае непрерывного приема МТ в сравне-нии с подходом, предполагающим временное прекраще-ние его использования. В то же время имеется множест-во работ, подтверждающих целесообразность использо-вания непрерывной схемы приема МТ у хирургических пациентов [14][15][16][17][18][19][20][21]. Самое большое исследование в этой области провели D. Grenann и соавт.…”

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