RESEARCH - Is MTX safe in the perioperative period in RA patients?

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ACR/ARHP 2008 Scientific Meeting

Session: Orthopedics, Low Back Pain, and Rehabilitation

Tuesday, Oct 28, 2008, 9:00 AM - 6:00 PM

Presentation: 1541 - Is Methotrexate Safe In The Perioperative Period

In Rheumatoid Arthritis Patients?

Author(s): Estibaliz Loza1, Martínez López2, Loreto

Carmona2, 3e Initiative 2007-2008. 1HospitalClínico San ,

Madrid, Spain; 2Research Unit, Fundación Española de Reumatología,

Madrid, Spain

Abstract: Purpose: To analyze the efficacy and safety of methotrexate

(MTX) in rheumatoid arthritis (RA) patients in the perioperative

period.

Methods: Systematic review of studies retrieved by a sensitive search

strategy in Medline (1961-July 2007), Embase (1961-July 2007),

Cochrane Library (up to July 2007), and from the abstracts of the ACR

(2005, 2006) and EULAR (2005-2007) annual scientific meetings.

Selection criteria: by population studies had to include patients with

RA undergoing a surgery; by intervention and control group continuing

MTX versus stopping MTX; and by the outcomes studies had to report

complications within 1 year after the surgery including infections,

wound morbidity, surgery complications, and RA flares. Two reviewers

screened the titles and abstracts of the retrieved articles for

selection criteria independently and collected the data by using ad

hoc standard forms. Randomized controlled trials (RCT) or high quality

cohort studies with a control group were included. For the grading of

the quality we used a modification of the Oxford Centre for

Evidence-based Medicine Levels of Evidence in its May 2001 update. A

hand search was completed by reviewing the references of the included

studies, and all the publications or other information provided by

experts were examined.

Results: A total of 39 articles were studied in detail of which 4 were

included. Patients from the 4 included studies were mostly women, with

mean ages around 60 years. All of them underwent elective orthopaedic

surgeries, and were taking MTX doses mainly from 5 mg/week to 10

mg/week. Patients who continued on MTX did not change the doses

perioperatively. By order of level of evidence, we found 2 RCT, in

which patients continuing on MTX did not report more infections or

problems related to wound morbidity, but statistically less RA flares.

In a cohort prospective study, in the MTX group 4 infections were

observed while none in the control group. Any disease flare was

reported in any group. Evidence from a retrospective study showed that

patients on MTX reported less cases of wound morbitity (p=0.038), RA

flares (p=0.050), and no differences related to infections compared to

those who stopped MTX.

Conclusions: Continuing with low-doses of MTX in non-complicated RA

patients does not increase the rate of complications in the

perioperative period.

http://www.abstractsonline.com/plan/start.aspx?mkey={5880E483-F47E-4EFF-A557-2EF\

143592815}

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