RESEARCH - Complications and features after joint surgery in RA patients treated with TNF blockers

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Rheumatology Advance Access published online on December 4, 2009

Rheumatology, doi:10.1093/rheumatology/kep376

Complications and features after joint surgery in rheumatoid arthritis

patients treated with tumour necrosis factor- blockers: perioperative

interruption of tumour necrosis factor- blockers decreases

complications?

Kosei Kawakami1, Katsunori Ikari1, Koichiro Kawamura1, So Tsukahara1,

Takuji Iwamoto1, Koichiro Yano1, Yu Sakuma1, Asami Tokita1 and Shigeki

Momohara1

1Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan.

Abstract

Objective. TNF- blockers reportedly increase the risk of complications

in rheumatic patients following surgery. Whereas deep venous

thrombosis (DVT) is a significant complication after orthopaedic

surgery of the lower limbs, the risk for DVT in RA patients receiving

TNF blockers remains unclear. The aim of this study was to identify

complications that can be attributed to the use of TNF- blocker

therapy.

Methods. In a retrospective 1:1 pair-matched case–control study, 64

anti-TNF-treated RA surgeries (TNF group) and 64 surgeries treated

with conventional DMARDs (DMARDS group) were evaluated for surgical

site infection (SSI), DVT and recurrence of arthritis (flare-up).

Multivariate logistic regression analysis was performed to test the

association of SSI or DVT with the putative risk factors.

Results. Regression analysis identified the use of TNF blockers as a

risk factor for SSI [P = 0.036; odds ratio (OR) = 21.80] and

development of DVT (P = 0.03; OR = 2.83) after major orthopaedic

surgery: 12.5% (8/64) of the patients in the TNF group had SSI,

whereas 2% (1/64) of those in the DMARDs group had SSI. Fifty-one per

cent (23/45) of the TNF group, but only 26% (12/45) of the DMARDs

group was DVT positive. Flare-ups during the perioperative period were

found in 17.2% (11/64) of all patients, and no delay in wound healing

occurred in either group.

Conclusions. These data suggest that the use of TNF blockers is a

likely cause of SSI and DVT development in RA patients following major

orthopaedic surgery.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep376v1?papetoc

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