Postoperative Joint Infections in Rheumatoid Arthritis Patients on Methotrexate Therapy

Carpenter, Margaret A.; West, Sterling G.; Vogelgesang, Scott A.; Jones, DeAnn

doi:10.3928/0147-7447-19960301-09

Cited by 78 publications

(3 citation statements)

References 5 publications

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“…There were eight eligible observational studies 12–19 . Most of the participants had undergone elective orthopaedic surgery (mostly arthroplasty), 12–17 one study also included participants who had undergone other types of surgery, 18 and one study included participants who had undergone cervical spine surgery 19 .…”

Section: Resultsmentioning

confidence: 99%

“…There were eight eligible observational studies. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Most of the participants had undergone elective orthopaedic surgery (mostly arthroplasty), 12 , 13 , 14 , 15 , 16 , 17 one study also included participants who had undergone other types of surgery, 18 and one study included participants who had undergone cervical spine surgery. 19 Four studies investigated perioperative discontinuation of bDMARDs, including TNF inhibitors 12 , 13 , 14 and abatacept, 14 two studies discontinuation of methotrexate, 16 , 17 and two studies discontinuation of combination DMARD therapy 18 or all DMARDs.…”

Section: Resultsmentioning

confidence: 99%

“… 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Most of the participants had undergone elective orthopaedic surgery (mostly arthroplasty), 12 , 13 , 14 , 15 , 16 , 17 one study also included participants who had undergone other types of surgery, 18 and one study included participants who had undergone cervical spine surgery. 19 Four studies investigated perioperative discontinuation of bDMARDs, including TNF inhibitors 12 , 13 , 14 and abatacept, 14 two studies discontinuation of methotrexate, 16 , 17 and two studies discontinuation of combination DMARD therapy 18 or all DMARDs. 18 Evidence from these studies largely concurred with the findings from RCTs, indicating there may be an increased risk of flare if DMARDs are discontinued, with no apparent reduction in risk of postoperative infection.…”

Section: Resultsmentioning

confidence: 99%

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Australian recommendations on perioperative use of disease‐modifying anti‐rheumatic drugs in people with inflammatory arthritis undergoing elective surgery

Buchbinder

Glennon

Johnston

et al. 2023

Internal Medicine Journal

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Disease-modifying anti-rheumatic drugs (DMARDs) are effective treatments for inflammatory arthritis but carry an increased risk of infection. For patients undergoing surgery, there is a need to consider the trade-off between a theoretical increased risk of infection with continuation of DMARDs perioperatively versus an increased risk of disease flare if they are temporarily withheld. We used the Grading of Recommendations Assessment, Development and Evaluation methodology to develop recommendations for perioperative use of DMARDs for people with inflammatory arthritis undergoing elective surgery. The recommendations form part of the National Health and Medical Research Council-endorsed Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis. Conditional recommendations were made against routinely discontinuing conventional synthetic and biologic (b) DMARDs in the perioperative period but to consider temporary discontinuation of bDMARDs in individuals with a high risk of infection or where the impact of infection would be severe. A conditional recommendation was made in favour of temporary discontinuation of targeted synthetic DMARDs in the perioperative period.

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