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Perioperative management of immunosuppression in patients with rheumatoid arthritis
- Source :
- Curr Opin Rheumatol
- Publication Year :
- 2019
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2019.
-
Abstract
- PURPOSE OF REVIEW: Patients with rheumatoid arthritis are at increased risk of infection after surgery. Recent literature has provided more data and updated guidelines to guide the management of immunosuppression in the perioperative period. RECENT FINDINGS: Studies over the past few years have confirmed that patients with rheumatoid arthritis are at increased risk of infection after surgery. Patients treated with biologics are at greater risk of post-operative infection, but this risk might be explained by the comorbidities and greater disease severity often seen in these patients. Recent observational studies have suggested that interruption of biologic therapies before surgery may not be associated with better outcomes. Glucocorticoids, however, have consistently been found to be risk factors for infection. Recent guidelines from the American College of Rheumatology/American Association of Hip and Knee Surgeons recommend continuing conventional disease modifying drugs and holding biologics for one dosing interval before surgery. SUMMARY: Prolonged interruption of conventional and biologic therapies before surgery does not appear to substantially reduce infection risk. Guidelines now recommend continuing conventional DMARDs and holding biologics for just one dosing interval before surgery. Glucocorticoids are strongly associated with the risk of post-operative infection and should be minimized before surgery.
- Subjects :
- 0301 basic medicine
medicine.medical_specialty
medicine.medical_treatment
MEDLINE
Arthritis
Article
Perioperative Care
Arthritis, Rheumatoid
03 medical and health sciences
0302 clinical medicine
Rheumatology
Humans
Medicine
In patient
Intensive care medicine
030203 arthritis & rheumatology
Perioperative management
business.industry
Immunosuppression
Perioperative
medicine.disease
030104 developmental biology
Increased risk
Antirheumatic Agents
Rheumatoid arthritis
business
Subjects
Details
- ISSN :
- 15316963 and 10408711
- Volume :
- 31
- Database :
- OpenAIRE
- Journal :
- Current Opinion in Rheumatology
- Accession number :
- edsair.doi.dedup.....f9b60a7793f80790caa060e2d5005d39