Risk of postoperative complications in rheumatoid arthritis relevant to treatment with biologic agents: a report from the Committee on Arthritis of the Japanese Orthopaedic Association

Évaluation du rapport bénéfice-risque de la suspension des anti-TNF alpha en chirurgie orale

“…En présence de PR, la majorité des études n'a pas identifié davantage de complications infectieuses postopératoires en cas de maintien des anti-TNF par rapport aux groupes les ayant suspendu [10][11][12][13][14][15]. La majorité des études n'a pas retrouvé plus de complications postopératoires entre le groupe ayant suspendu son traitement par anti-TNF et le groupe témoin sous nbDMARDs [9,[20][21][22]. En revanche, il est difficile de conclure car les études sont essentiellement rétrospectives, les échantillons sont souvent réduits, il manque des informations sur la nature des complications, l'éventuelle prescription d'antibioprophylaxie en préopératoire, les cofacteurs de morbidité ou encore la durée de suspension variable des anti-TNF.…”

“…Deux études concluaient à un risque de complications supérieur pour les patients ayant suspendu leur traitement anti-TNF [7,19]. Quatre études retrouvaient des résultats similaires pour chacun des groupes [9,[20][21][22].…”

Perioperative Surgical Site Infections and Complications in Elective Orthopedic Surgery in Patients with Rheumatoid Arthritis Treated with Anti-Tumor Necrosis Factor-Alpha Agents − Discontinue or Not, Clinical Dilemma

“…TNF blockers (IFX; 35 The Committee on Arthritis of the Japanese Orthopedic Association [29] investigated the prevalence of postoperative complications in patients with RA in teaching hospitals in Japan. The number of surgical procedures under treatment with biologic agent was 3,468 (IFX; 1,616, ETN; 1686, ADA; 41, TCZ; 102, abatacept; 23) and the prevalence of infection was 1.3% (46 procedures).…”

“…In 4 studies [13,[22][23][24], perioperative continuation of anti-TNF therapy did not increase the risk of SSI, whereas in 3 studies [27][28][29], the risk of SSI was increased in anti-TNF therapy group, regardless of discontinuation of the therapy perioperatively. Another point of view, preopera-tive discontinuation of TNF blockers causes the reduction of effects of the agents at the operation date, thus the results of these studies may not show the accurate influences of TNF blockers on the risk of SSI.…”

“…However, in the other four studies [25,26,30,31], appropriate preoperative discontinuation of TNF blockers did not increase the risk of SSI compared with group on nbDMARDs. The risk factors for SSI, which most of RA patients undergoing TJA are considered to have, reported in 17 studies were the use of TNF blockers (OR 21.80 [27], OR 5.69 [28], and OR 4.4 [33]), prednisone dosage (OR 1.433) [27], increased daily steroid intake (OR 5.0 per 5mg/day increase) [32], longer disease duration (OR 1.169 [27] and OR 1.09 [28]), history of prior SSI or skin infection (OR 13.8) [24], primary or revision TJA for the joint subsequently infected within the last year (OR 88.3) [32], and "clean" surgical procedure such as TJA (OR 2.12) [29]. Thus, it may be preferable to perform TJA, if needed, before the induction of TNF blockers [32].…”