‘Should we stop or continue conventional synthetic (including glucocorticoids) and targeted DMARDs before surgery in patients with inflammatory rheumatic diseases?’

Abstract

Total hip and total knee arthroplasty) remain important interventions to treat symptomatic knee and hip damage in patients with rheumatoid arthritis, with little change in utilisation rates despite the increasingly widespread use of potent conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and targeted DMARDs including Janus kinase inhibitors and biologics. The majority of patients are receiving these immunosuppressing medications and glucocorticoids at the time they present for arthroplasty. There is minimal randomised controlled trial data addressing the use of DMARDs in the perioperative period, yet patients and their physicians face these decisions daily. This paper reviews what is known regarding perioperative management of targeted and csDMARDs and glucocorticoids.

A Comparative Study of Total Knee Arthroplasty Outcome for Stiff Knee with or without Sequential Antirheumatic Drug Treatment

“…The main antirheumatic drugs used are: Non-steroidal anti-in ammation drugs; Glucocorticoids, local injection to treat refractory peripheral arthritis; Rheumatology medication, the drugs recommended by the American Academy of Rheumatology classi cation standards mainly include sulfasalazine and methotrexate and le unomide, etc. ; Biological agents, TNF antagonists are the rst choice, which can improve the pain and function of the axial joints; Thalidomide, special patients, when other related drugs have no effect, these drugs can signi cantly improve clinical symptoms 7 .…”

A comparative study of total knee arthroplasty outcome for stiff knee with or without sequential antirheumatic drug treatment

“…The main antirheumatic drugs used are (1) Nonsteroidal anti-inflammation drugs; (2) glucocorticoids, local injection to treat refractory peripheral arthritis; (3) rheumatology medication, the drugs recommended by the American Academy of Rheumatology classification standards mainly include sulfasalazine and methotrexate and leflunomide, etc. ; (4) biological agents, TNF antagonists are the first choice, which can improve the pain and function of the axial joints; (5) thalidomide, for special patients (when other related drugs have no effect, these drugs can significantly improve clinical symptoms) [ 7 ].…”

Perioperative management of patients with inflammatory rheumatic diseases

“…2nd Search on 26 November 2020: repeat of 1st search with substance names: (results) methotrexate (100), leflunomide (11), sulfasalazine (7), hydroxychloroquine (17), mycophenolate (3), cyclophosphamide (2), azathioprine (8), cyclosporin (6), adalimumab (11), etanercept (10), infliximab (16), golimumab(4), certolizumab (3), TNFalpha (48), tumour necrosis factor (11), abatacept (11), rituximab (16), tocilizumab (20), tofaciƟnib (5), bariciƟnib (1), upadaciƟnib (0), filgoƟnib (0), JAK inhibitor* (1), belimumab (2), ustekinumab (3), secukinumab (2), anakinra (4), canakinumab (3), ixekizumab (0), apremilast (0), sarilumab (0), guselkumab (0) The perioperative management of patients with inflammatory rheumatic diseases remains a complex challenge due to the variety of immunosuppressive and immunomodulatory therapies currently used. Data from the national database of the German Collaborative Arthritis Centers show that the number of patients with rheumatoid arthritis (RA) requiring surgical joint interventions has decreased by more than 50% over the past 20 years [1].…”