Review article

RECOMMENDATIONS FOR BIOLOGICAL THERAPY TREATMENT IN PATIENTS UNDERGOING SURGICAL PROCEDURES OF THE MUSCULOSKELETAL SYSTEM

Frane Grubišić ; Klinika za reumatologiju, fizikalnu medicinu i rehabilitaciju, Medicinski fakultet Sveučilišta u Zagrebu, KBC Sestre milosrdnice, Zagreb
Miroslav Mayer ; Zavod za kliničku imunologiju i reumatologiju, Klinika za unutarnje bolesti, Medicinski fakultet Sveučilišta u Zagrebu, KBC Zagreb

Abstract

Elective hip or knee arthroplasty remains the treatment of choice for RA, PsA, or AS patients with severe and advanced secondary degenerative changes as a result of inflammatory processes. The main objective of this paper is to present recommendations for the use of both conventional and biologic disease-modifying antirheumatic drugs in the perioperative period. Clinicians may face a number of challenges in their patients such as increased risk of infection, prolonged wound healing, and flares of inflammatory rheumatic disease due to discontinuation of biological therapy. Based on the data presented in this paper, continuation of conventional disease-modifying antirheumatic drugs is not only associated with a significantly decreased risk of infection, but may also prevent flares of arthritis. Glucocorticoids should be completely withheld or should be prescribed in the lowest dose in order to avoid the risk of infection and prolonged wound healing. As for the biologic disease modifying antirheumatic drugs in the perioperative period, TNF-alpha inhibitors should be withheld within a certain time frame prior to the surgical procedure in order to avoid unwanted complications. Also, tocilizumab, rituximab, and JAK inhibitors can be administered during the perioperative period although data are scarce. Data on perioperative use of secukinumab are lacking, and the IL12/23 inhibitor ustekinumab has been shown to be safe. Prior to the restart of biological therapy, usually 14 days aft er the surgery, it is important to evaluate that the wound shows evidence of healing and no signs of inflammation.

Keywords

Rheumatoid arthritis; Psoriatic arthritis; Ankylosing spondylitis; Antirheumatic agents; Biological products; Glucocorticoids; Tumor necrosis factor-alpha – antagonists; Perioperative care; Postoperative complications; Surgical wound infection; Wound healing; Orthopedic procedures; Practice guidelines as topic

Hrčak ID:

212257

URI

https://hrcak.srce.hr/212257

Publication date:

6.12.2018.

Article data in other languages: croatian

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