Perioperative management of patients with rheumatoid arthritis in the era of biologic response modifiers

[Guest guest]

Curr Opin Rheumatol. 2004 May;16(3):192-8.

Perioperative management of patients with rheumatoid arthritis in the

era of biologic response modifiers.

ndich PA, Kelley JT 3rd, Conn DL.

Division of Rheumatology, Department of Medicine, Emory University

School of Medicine, 49 Street SE, Atlanta, GA 30303, USA.

PURPOSE OF REVIEW: This article provides guidelines for the

perioperative management of the most commonly used antirheumatic drugs being

used to treat patients with rheumatoid arthritis, with an emphasis on the

relatively new addition of biologic response modifiers. RECENT FINDINGS: Few

clinical data exist examining the perioperative management of the biologic

drugs, which include the inhibitors of tumor necrosis factor-alpha

(etanercept, infliximab, and adalimumab), the interleukin-1 receptor

antagonist anakinra, and to a much lesser extent the CD20 inhibitor

rituximab. The only human data available in that regard is based on the use

of the tumor necrosis factor-alpha inhibitor infliximab in surgical patients

with Crohn disease. Although quite limited, that data appeared favorable in

finding that infliximab did not result in an increased risk of postoperative

complications in that setting. SUMMARY: Perioperative guidelines have never

been well established for a majority of the traditional antirheumatic drugs

in use today. Recommendations for the perioperative use of nonsteroidal

antiinflammatory drugs and glucocorticoids have the most evidence-based

support. Data for the use of methotrexate are also available from which to

generate reasonable guidelines; however, for the remaining antirheumatic

drugs in current use, the available data cannot support any clear

evidence-based recommendations. To provide reasonable guidelines for the use

of the biologics, perhaps the best we can do is to extrapolate from the very

limited data coming from the concurrent use of infliximab in patients with

Crohn disease who have undergone surgery. Beyond that, we are left with

animal and tissue culture data from which any recommendations would be

rather tenuous.

PMID: 15103244 [PubMed]