Update on the Japanese guidelines for the use of infliximab and etanercept in rheumatoid arthritis

Abstract

Периоперационное ведение больных ревматоидным артритомАмирджанова В.Н., Макаров М.А., Бялик Е.И., Макаров С.А., Липина М.М В статье рассматриваются рекомендации по совместному ведению больных ревматоидным артритом, нуждающихся в эндопротезировании крупных суставов нижних конечностей, ревматологами и травма-тологами-ортопедами. В связи с отсутствием общепринятых стандартов и рекомендаций по периоперативному ведению боль-ных с ревматическими заболеваниями, принятых международными ревматологическими ассоциация-ми, в статье обобщен собственный опыт ведения пациентов с учетом международных подходов и реко-мендаций разных стран. Обсуждаются подходы к оценке и снижению рисков кардиоваскулярной пато-логии, профилактики инфекционных осложнений, кровотечений, тромбозов глубоких вен нижних ко-нечностей, особенности ведения больных с остеопорозом. Подробно представлен опыт ведения боль-ных, получающих антиревматическую терапию нестероидными противовоспалительными препарата-ми, базисными противовоспалительными препаратами: метотрексатом, лефлуномидом, сульфасалази-ном, гидроксихлорохином. Даются рекомендации по ведению больных, получающих глюкокортикоиды и генно-инженерные биологические препараты (ингибиторы фактора некроза опухоли α, анти-В-кле-точную терапию и ингибиторы рецепторов интерлейкина 6), в предоперационном и послеоперацион-ном периоде. Ключевые слова: ревматоидный артрит; эндопротезирование суставов; базисные противовспалительные пре-параты; генно-инженерные биологические препараты. Для ссылки: Амирджанова ВН, Макаров МА, Бялик ЕИ и др. Периоперационное ведение больных ревмато-идным артритом. Научно-практическая ревматология. 2014;52(4)366-375. PERIOPERATIVE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS Amirdzhanova V.N., Makarov M.A., Byalik E.I., Makarov S.A., Lipina M.M.The paper considers the joint management of rheumatoid arthritis patients needing endoprosthetic replacement of the large joints of the lower extremities by rheumatologists and orthopedic traumatologists. Due to the fact that there are no conventional standards or guidelines for the perioperative management of patients with rheumatic diseases, adopted by international rheumatology associations, the authors generalize their experience in managing the patients in terms of international approaches and guidelines from different countries. The medical assessment and reduction of cardiovascular risks, the prevention of infectious complications, hemorrhages, and lower extremity deep vein thrombosis, and the specific features of management of patients with osteoporosis are under consideration. The authors' experience in managing the patients receiving antirheumatic therapy with nonsteroidal antiinflammatory and disease-modifying antirheumatic drugs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, is detailed. Recommendations for managing patients taking glucocorticoids and biologic agents (tumor necrosis factor-α inhibitors, anti-B-cell therapy, and interleukin-6 receptor inhibitors) in the preoperative and postoperative p...

Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs

“…In this study, surgery was timed in accordance with the guidelines of both the British Society for Rheumatology and the Japan College of Rheumatology [19,20]. The ACR also recommends that biologic agents should not be used during the perioperative period, for at least 1 week prior to and 1 week after surgery; the ACR also recommends that this decision be further tempered by the pharmacokinetic properties of a given biologic agent (e.g., longer periods of therapy cessation may be appropriate when using agents with longer half-lives) and by the type of surgery [27].…”

“…Nonbiologic DMARDs as a rule were continued perioperatively but were administered cautiously in individual cases if the patients had comorbidities or were elderly. As mentioned above, the timing of surgery for patients treated with TNF blockers was performed in accordance with British Society for Rheumatology and Japan College of Rheumatology guidelines [19,20]. These guidelines recommend that TNF-blocker treatment should be withheld for 2-4 weeks prior to major surgical procedures: specifically, 2-4 weeks for ETN and ADA versus 4 weeks for IFX, due to its relatively long half-life.…”

“…The British Society for Rheumatology guidelines and the Japanese College of Rheumatology recommend withholding IFX, ETN, and ADA for 2-4 weeks prior to major surgical procedures. Treatment may be restarted postoperatively once wound healing is satisfactory if there is no evidence of infection [19,20]. We followed these guidelines for RA surgeries in our patients, assessed SSI following joint surgery in RA patients treated with nonbiologic and biologic DMARDs, and validated whether perioperative interruption of biologic DMARD therapy decreased the incidence of SSI complications.…”

Comparison of QuantiFERON-TB Gold and the tuberculin skin test for detecting previous tuberculosis infection evaluated by chest CT findings in Japanese rheumatoid arthritis patients

“…Although latent tuberculosis infection (LTBI) screening policies vary considerably among countries, it is generally recommended that all RA patients undergo screening for LTBI before starting treatment with TNF inhibitors, and administration of prophylactic anti-TB drugs, such as isoniazid (INH), has been proposed. In Japanese guideline before the starting of biologics, assessing previous TB infection was required and was assessed by patient interviews of past history of TB, tuberculin skin test (TST), and chest radiographic findings [5]. It is important to evaluate the presence or absence of previous exposure to TB infection to avoid reactivation of TB in an intermediate TB endemic area such as Japan.…”

Biological agents for endoprosthetic joint replacement in patients with rheumatoid arthritis

“…Хотя до сих пор этот вопрос остается открытым, ученые разных стран пришли к выводу, что при периоперационном планировании необхо-димо учитывать период полувыведения препарата [20][21][22][23]. Данное положение поддерживается и отечественными спе-циалистами [24].…”