Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty (Part 2)
We continue this week with our our discussion on the specitic guideline in the management of antirheumatic medication for those patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Before we jump into this week’s discussion, we need to review what was discussed in the latest issue of this column.
The quality of life of rheumatic disease patients has improved with the use of disease-modifying antirheumatic drugs (DMARDs) and biologic drugs.
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 of rheumatic diseases.
There is a guideline for the use of medication to those who underwent TKA and THA.
Experts require the guidelines in relation with perioperative management of antirheumatic drugs.
However, this guideline does not address specific indications for THA or TKA as the decisions are normally not related to antirheumatic drug therapy, the kind of implant, surgical procedure, or perioperative evaluation and management of present disease, for example the impact on the cervical spine of patients with rheumatic arthritis (RA).
Although patients with RA, spondyloarthritis (SpA), juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE), should be appraised for risk of venous thromboembolism and major acute coronary event, the guideline does not address cardiac risk assessment or perioperative venous thromboembolism prophylaxis. There is an existing guideline cardiac risk assessment or perioperative venous thromboembolism prophylaxis.
Patients with rheumatic diseases who underwent THA and TKA are at increased risks for the infection of the periprosthetic joint.
The management of antirheumatic medication in the perioperative period provides an opportunity to lower the risks, according to the experts.
Nonbiologic disease-modifying antirheumatic drugs may be used during the perioperative period in patients with rheumatic diseases who are undergoing elective THA and TKA procedure.
Biologic medications should be limited to as close to 1 dosing cycle as possible before the elective THA and TKA and should resume after there is a piece of evidence of wound healing, which typically 2 weeks, for all patients with rheumatic diseases.Next week, we will be making an in depth discussion on the management of antirheumatic drugs for people who underwent TKA and THA.