Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty (Part 1)
This week, we will start our discussion on the management of the use of rheumatic drugs for those patients with Elective Total Hip or Total Knee Arthroplasty.
While the use of disease-modifying antirheumatic drugs (DMARDs) and biologic drugs have improved the quality of life for patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE), rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain significantly high.
The patients with the stated conditions bare dramatic improvement in pain and function after THA or TKA, yet critical results such as infection, dislocation, and readmission are reported to be still at a high rate for patients with RA, SpA, or SLE compared to patients with osteoarthritis.
During arthroplasty in a high-volume orthopedic hospital, 46% of RA patients are getting biologic drugs, 67% were receiving nonbiologic DMARDs, and 25% were administered glucocorticosteroids, while 75% of patients with SLE were given immunosuppressive medications, and 15% were having glucocorticosteroids.
The key strategy to manage these drugs is not fully understood. The pressing risk factors for infection, such as overall disability and disease severity, may not be easily modified, but the optimal outlook of the management of immunosuppressant therapy around the time of arthroplasty may offer a possibility to lower the potential risk.
For this reason, there are guidelines set by experts for the proper use of these drugs for those who elected to get TKA or THA.
Experts require the guidelines in relation with perioperative management of antirheumatic drugs.
However, pieces of evidence telling us about these drugs effects on perioperative management are too few at this point.
There are no randomized controlled trials (RCTs) looking at the stopping and reintroduction of biologic agents during THA or TKA.
The important results appraised for these guidelines are the potential hike in the risk for infection that could be caused by the medications versus the disease flare risk when the drugs are not administered.
The expert guideline is applicable only to adult patients with RA, SpA including those with ankylosing spondylitis (AS) and psoriatic arthritis (PsA), JIA, or SLE, who are undergoing elective THA or TKA, and incorporates patient choices.
This guideline addresses management of antirheumatic medication in those adult patients with diagnoses of RA, SpA, JIA, or SLE, but is not limited to those who meet classification criteria.
Next week we will be making a deeper dive on the specific guideline that will address usual scenarios, but may not be applicable in all cases.
It is important that there is an open communication between the patient, doctor for the drug management to be a success.