INFO - Perioperative management of patients with RA in the era of biologic response modifiers

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Curr Opin Rheumatol. 2004 May;16(3):192-8.

Perioperative management of patients with rheumatoid arthritis in the era of

biologic response modifiers.

ndich PA, Kelley JT 3rd, Conn DL.

Division of Rheumatology, Department of Medicine, Emory University School of

Medicine, 49 Street SE, Atlanta, GA 30303, USA.

PURPOSE OF REVIEW: This article provides guidelines for the perioperative

management of the most commonly used antirheumatic drugs being used to treat

patients with rheumatoid arthritis, with an emphasis on the relatively new

addition of biologic response modifiers. RECENT FINDINGS: Few clinical data

exist examining the perioperative management of the biologic drugs, which

include the inhibitors of tumor necrosis factor-alpha (etanercept,

infliximab, and adalimumab), the interleukin-1 receptor antagonist anakinra,

and to a much lesser extent the CD20 inhibitor rituximab. The only human

data available in that regard is based on the use of the tumor necrosis

factor-alpha inhibitor infliximab in surgical patients with Crohn disease.

Although quite limited, that data appeared favorable in finding that

infliximab did not result in an increased risk of postoperative

complications in that setting.

SUMMARY: Perioperative guidelines have never been well established for a

majority of the traditional antirheumatic drugs in use today.

Recommendations for the perioperative use of nonsteroidal antiinflammatory

drugs and glucocorticoids have the most evidence-based support. Data for the

use of methotrexate are also available from which to generate reasonable

guidelines; however, for the remaining antirheumatic drugs in current use,

the available data cannot support any clear evidence-based recommendations.

To provide reasonable guidelines for the use of the biologics, perhaps the

best we can do is to extrapolate from the very limited data coming from the

concurrent use of infliximab in patients with Crohn disease who have

undergone surgery. Beyond that, we are left with animal and tissue culture

data from which any recommendations would be rather tenuous.

PMID: 15103244

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5103244 & dopt=Abstract

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