Skip to main content
Log in

Perioperativer Umgang mit der Therapie von Patienten mit entzündlich rheumatischen Erkrankungen

Aktualisierte Empfehlungen der Deutschen Gesellschaft für Rheumatologie

Perioperative management of treatment of patients with inflammatory rheumatic diseases

Updated recommendations of the German Society of Rheumatology

  • Empfehlungen und Stellungnahmen von Fachgesellschaften
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Vor operativen Eingriffen stellt sich Ärzten und Patienten mit entzündlich rheumatischen Erkrankungen weiterhin die Frage nach einer Unterbrechung oder Fortsetzung der entzündungshemmenden Medikation. Die Deutsche Gesellschaft für Rheumatologie hat hierfür ihre Empfehlungen von 2014 aktualisiert.

Methoden

Nach einer systematischen Literaturrecherche mit Einschluss von Publikationen bis zum 31.08.2021 wurden die Empfehlungen zum Umgang mit Glukokortikoiden, konventionell synthetischen „disease-modifying antirheumatic drugs“ (csDMARDs) und Biologika (bDMARDs) überarbeitet und Empfehlungen zu neueren Substanzen und „targeted synthetic (ts) DMARDs“ ergänzt.

Ergebnisse

Die Glukokortikoiddosis sollte 2 bis 3 Monate vor elektiven Eingriffen so niedrig wie möglich reduziert (in jedem Fall <10 mg/Tag), 1 bis 2 Wochen vor und am Operationstag jedoch stabil gehalten werden. csDMARDs können in vielen Fällen fortgeführt werden, Ausnahmen sind eine Reduktion hoher Methotrexat-Dosierungen auf ≤15 mg/Woche und Auswaschen des Leflunomid bei hohem Infektionsrisiko. Azathioprin, Mycophenolat und Ciclosporin sollten 1 bis 2 Tage vor der Operation pausiert werden. Unter bDMARDs können Operationen zum Ende des jeweiligen Therapieintervalls geplant werden. Januskinase(JAK)-Inhibitoren sollten bei größeren Eingriffen für 3 bis 4 Tage pausiert werden. Apremilast kann fortgeführt werden. Bei notwendiger Unterbrechung gilt für alle Substanzen, die Therapie in Abhängigkeit der Wundheilung baldmöglichst wieder zu beginnen.

Schlussfolgerungen

Ob bDMARDs das Infektionsrisiko perioperativ erhöhen und welche Rolle die Absetzzeit dabei spielt, bleibt bei gegenwärtiger Evidenz noch unklar. Um das Risiko eines Krankheitsschubs unter längerer Therapiepause zu minimieren, wurde in den aktualisierten Empfehlungen die perioperative Pausierung von bDMARDs von mindestens 2 Halbwertszeiten auf ein Therapieintervall reduziert.

Abstract

Background

Prior to surgical interventions physicians and patients with inflammatory rheumatic diseases remain concerned about interrupting or continuing anti-inflammatory medication. For this reason, the German Society for Rheumatology has updated its recommendations from 2014.

Methods

After a systematic literature search including publications up to 31 August 2021, the recommendations on the use of of glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics (bDMARDs) were revised and recommendations on newer drugs and targeted synthetic (ts)DMARDs were added.

Results

The glucocorticoid dose should be reduced to as low as possible 2–3 months before elective surgery (in any case <10 mg/day) but should be kept stable 1–2 weeks before and on the day of surgery. In many cases csDMARDs can be continued, exceptions being a reduction of high methotrexate doses to ≤15 mg/week and wash-out of leflunomide if there is a high risk of infection. Azathioprine, mycophenolate and ciclosporin should be paused 1–2 days prior to surgery. Under bDMARDs surgery can be scheduled for the end of each treatment interval. For major interventions Janus kinase (JAK) inhibitors should be paused for 3–4 days. Apremilast can be continued. If interruption is necessary, treatment should be restarted as soon as possible for all substances, depending on wound healing.

Conclusion

Whether bDMARDs increase the perioperative risk of infection and the benefits and risks of discontinuation remain unclear based on the currently available evidence. To minimize the risk of a disease relapse under longer treatment pauses, in the updated recommendations the perioperative interruption of bDMARDs was reduced from at least two half-lives to one treatment interval.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Callhoff J, Thiele K, Henes J, Richter J, Aringer M, Zink A, Albrecht K (2018) Deutlicher Rückgang von Gelenkoperationen bei Patienten mit rheumatoider Arthritis: Ergebnisse der Kerndokumentation 1996–2016. German Medical Science GMS Publishing House, Düsseldorf https://doi.org/10.3205/18dgrh057

    Book  Google Scholar 

  2. Krüger K, Albrecht K, Rehart S, Scholz R, Kommission Pharmakotherapie der DGRh (2014) Empfehlungen der Deutschen Gesellschaft für Rheumatologie zur perioperativen Vorgehensweise unter Therapie mit DMARD und Biologicals bei entzündlich-rheumatischen Erkrankungen. Z Rheumatol 73(1):77–84. https://doi.org/10.1007/s00393-013-1301-z

    Article  CAS  PubMed  Google Scholar 

  3. Krüger K (2017) Perioperatives Management bei Gelenkeingriffen unter immunsuppressiver Therapie. Z Rheumatol 76(9):767–775. https://doi.org/10.1007/s00393-017-0379-0

    Article  PubMed  Google Scholar 

  4. Goodman SM, Springer B, Guyatt G et al (2017) 2017 American college of rheumatology/American association of hip and knee surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Rheumatol 69(8):1538–1551. https://doi.org/10.1002/art.40149

    Article  PubMed  Google Scholar 

  5. Goodman SM, George MD (2020) Should we stop or continue conventional synthetic (including glucocorticoids) and targeted DMARDs before surgery in patients with inflammatory rheumatic diseases? RMD Open. https://doi.org/10.1136/rmdopen-2020-001214

    Article  PubMed  PubMed Central  Google Scholar 

  6. Premkumar A, Morse K, Levack AE, Bostrom MP, Carli AV (2018) Periprosthetic joint infection in patients with inflammatory joint disease: prevention and diagnosis. Curr Rheumatol Rep 20(11):68. https://doi.org/10.1007/s11926-018-0777-6

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rehart S, Wickler B, Henniger M (2020) Perioperatives Management bei der Traumaversorgung von „Rheumatikern“ unter Immunsuppression. Unfallchirurg 123(8):588–596. https://doi.org/10.1007/s00113-020-00826-2

    Article  CAS  PubMed  Google Scholar 

  8. Chalmers BP, Weston JT, Osmon DR, Hanssen AD, Berry DJ, Abdel MP (2019) Prior hip or knee prosthetic joint infection in another joint increases risk three-fold of prosthetic joint infection after primary total knee arthroplasty: a matched control study. Bone Joint J 101(7):91–97. https://doi.org/10.1302/0301-620X.101B7.BJJ-2018-1189.R1

    Article  PubMed  Google Scholar 

  9. Schiegnitz EA, Hoefert S, Otto S et al (2018) S3-Leitlinie Antiresorptiva-assoziierte Kiefernekrosen (AR-ONJ). https://www.awmf.org/uploads/tx_szleitlinien/007-091l_S3_Antiresorptiva-assoziierte-Kiefernekrosen-AR-ONJ_2018-12.pdf. Zugegriffen: 1. Sept. 2021

  10. Hoefert S (2019) Medikamenten-assoziierte Kiefernekrosen – Relevanz aus rheumatologischer Sicht? Arthritis Rheuma 39:385–390. https://doi.org/10.1055/a-1037-0874

    Article  Google Scholar 

  11. George MD, Baker JF, Winthrop K, Curtis JR (2019) Risk of biologics and glucocorticoids in patients with rheumatoid arthritis undergoing arthroplasty. Ann Intern Med 171(9):680. https://doi.org/10.7326/L19-0528

    Article  PubMed  Google Scholar 

  12. George MD, Baker JF, Winthrop KL et al (2020) Immunosuppression and the risk of readmission and mortality in patients with rheumatoid arthritis undergoing hip fracture, abdominopelvic and cardiac surgery. Ann Rheum Dis 79(5):573–580. https://doi.org/10.1136/annrheumdis-2019-216802

    Article  CAS  PubMed  Google Scholar 

  13. Cordtz RL, Zobbe K, Hojgaard P (2018) Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers. Ann Rheum Dis 77(2):281–288. https://doi.org/10.1136/annrheumdis-2017-212339

    Article  CAS  PubMed  Google Scholar 

  14. Kittle H, Ormseth A, Patetta MJ, Sood A, Gonzalez MH (2020) Chronic corticosteroid use as a risk factor for perioperative complications in patients undergoing total joint arthroplasty. J Am Acad Orthop Surg Glob Res Rev 4(7):e2000001. https://doi.org/10.5435/JAAOSGlobal-D-20-00001

    Article  PubMed  Google Scholar 

  15. Somayaji R, Barnabe C, Martin L (2013) Risk factors for infection following total joint arthroplasty in rheumatoid arthritis. Open Rheumatol J 7:119–124. https://doi.org/10.2174/1874312920131210005

    Article  PubMed  PubMed Central  Google Scholar 

  16. Au K, Reed G, Curtis JR, Kremer JM, Greenberg JD, Strand V, Furst DE, Investigators C (2011) High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis 70(5):785–791. https://doi.org/10.1136/ard.2010.128637

    Article  PubMed  Google Scholar 

  17. Marik PE, Varon J (2008) Requirement of perioperative stress doses of corticosteroids: a systematic review of the literature. Arch Surg 143(12):1222–1226. https://doi.org/10.1001/archsurg.143.12.1222

    Article  CAS  PubMed  Google Scholar 

  18. Grennan DM, Gray J, Loudon J, Fear S (2001) Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis 60(3):214–217. https://doi.org/10.1136/ard.60.3.214

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Sany J, Anaya JM, Canovas F, Combe B, Jorgensen C, Saker S, Thaury MN, Gavroy JP (1993) Influence of methotrexate on the frequency of postoperative infectious complications in patients with rheumatoid arthritis. J Rheumatol 20(7):1129–1132

    CAS  PubMed  Google Scholar 

  20. Afzali A, Park CJ, Zhu K, Hu JK, Sharma P, Sinanan MN, Lee SD (2016) Preoperative use of methotrexate and the risk of early postoperative complications in patients with inflammatory bowel disease. Inflamm Bowel Dis 22(8):1887–1895. https://doi.org/10.1097/MIB.0000000000000780

    Article  PubMed  Google Scholar 

  21. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S (2003) Examination of the risk of continuous leflunomide treatment on the incidence of infectious complications after joint arthroplasty in patients with rheumatoid arthritis. J Clin Rheumatol 9(2):115–118. https://doi.org/10.1097/01.RHU.0000062514.54375.bd

    Article  PubMed  Google Scholar 

  22. Fuerst M, Mohl H, Baumgartel K, Ruther W (2006) Leflunomide increases the risk of early healing complications in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Rheumatol Int 26(12):1138–1142. https://doi.org/10.1007/s00296-006-0138-z

    Article  CAS  PubMed  Google Scholar 

  23. den Broeder AA, Creemers MC, Fransen J, de Jong E, de Rooij DJ, Wymenga A, de Waal-Malefijt M, van den Hoogen FH (2007) Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study. J Rheumatol 34(4):689–695

    Google Scholar 

  24. Clay M, Mazouyes A, Gilson M, Gaudin P, Baillet A (2016) Risk of postoperative infections and the discontinuation of TNF inhibitors in patients with rheumatoid arthritis: a meta-analysis. Joint Bone Spine 83(6):701–705. https://doi.org/10.1016/j.jbspin.2015.10.019

    Article  CAS  PubMed  Google Scholar 

  25. Goodman SM, Menon I, Christos PJ, Smethurst R, Bykerk VP (2016) Management of perioperative tumour necrosis factor alpha inhibitors in rheumatoid arthritis patients undergoing arthroplasty: a systematic review and meta-analysis. Rheumatology (Oxford) 55(3):573–582. https://doi.org/10.1093/rheumatology/kev364

    Article  Google Scholar 

  26. Mabille C, Degboe Y, Constantin A, Barnetche T, Cantagrel A, Ruyssen-Witrand A (2017) Infectious risk associated to orthopaedic surgery for rheumatoid arthritis patients treated by anti-TNFalpha. Joint Bone Spine 84(4):441–445. https://doi.org/10.1016/j.jbspin.2016.06.011

    Article  CAS  PubMed  Google Scholar 

  27. Kubota A, Sekiguchi M, Nakamura T, Miyazaki Y, Suguro T (2014) Does use of a biologic agent increase the incidence of postoperative infection in surgery for rheumatoid arthritis after total joint arthroplasty? Mod Rheumatol 24(3):430–433. https://doi.org/10.3109/14397595.2013.844387

    Article  CAS  PubMed  Google Scholar 

  28. Borgas Y, Gulfe A, Kindt M, Stefansdottir A (2020) Anti-rheumatic treatment and prosthetic joint infection: an observational study in 494 elective hip and knee arthroplasties. BMC Musculoskelet Disord 21(1):410. https://doi.org/10.1186/s12891-020-03459-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. George MD, Baker JF, Hsu JY, Wu Q, Xie F, Chen L, Yun H, Curtis JR (2017) Perioperative timing of Infliximab and the risk of serious infection after elective hip and knee arthroplasty. Arthritis Care Res (Hoboken) 69(12):1845–1854. https://doi.org/10.1002/acr.23209

    Article  CAS  Google Scholar 

  30. Ward MM, Dasgupta A (2020) Pre-operative withholding of infliximab and the risk of infections after major surgery in patients with rheumatoid arthritis. Rheumatology (Oxford) 59(12):3917–3926. https://doi.org/10.1093/rheumatology/keaa291

    Article  CAS  Google Scholar 

  31. Strangfeld A, Eveslage M, Schneider M, Bergerhausen HJ, Klopsch T, Zink A, Listing J (2011) Treatment benefit or survival of the fittest: what drives the time-dependent decrease in serious infection rates under TNF inhibition and what does this imply for the individual patient? Ann Rheum Dis 70(11):1914–1920. https://doi.org/10.1136/ard.2011.151043

    Article  CAS  PubMed  Google Scholar 

  32. Ito H, Murata K, Sobue Y, Kojima T, Nishida K, Matsushita I, Kawahito Y, Kojima M, Hirata S, Kaneko Y, Kishimoto M, Kohno M, Mori M, Morinobu A, Murashima A, Seto Y, Sugihara T, Tanaka E, Nakayama T, Harigai M (2021) Comprehensive risk analysis of postoperative complications in patients with rheumatoid arthritis for the 2020 update of the Japan college of rheumatology clinical practice guidelines for the management of rheumatoid arthritis. Mod Rheumatol. https://doi.org/10.1080/14397595.2021.1913824

    Article  PubMed  Google Scholar 

  33. Latourte A, Gottenberg JE, Luxembourger C, Pane I, Claudepierre P, Richette P, Lafforgue P, Combe B, Cantagrel A, Sibilia J, Flipo RM, Gaudin P, Vittecoq O, Schaeverbeke T, Dougados M, Sellam J, Ravaud P, Mariette X, Seror R (2017) Safety of surgery in patients with rheumatoid arthritis treated by abatacept: data from the French Orencia in rheumatoid arthritis registry. Rheumatology (Oxford) 56(4):629–637. https://doi.org/10.1093/rheumatology/kew476

    Article  CAS  Google Scholar 

  34. Ito H, Tsuji S, Nakayama M, Mochida Y, Nishida K, Ishikawa H, Kojima T, Matsumoto T, Kubota A, Mochizuki T, Sakuraba K, Matsushita I, Nakajima A, Hara R, Haraguchi A, Matsubara T, Kanbe K, Nakagawa N, Hamaguchi M, Momohara S, Consortium J (2020) Does abatacept increase postoperative adverse events in rheumatoid arthritis compared with conventional synthetic disease-modifying drugs? J Rheumatol 47(4):502–509. https://doi.org/10.3899/jrheum.181100

    Article  PubMed  Google Scholar 

  35. George MD, Baker JF, Winthrop K, Alemao E, Chen L, Connolly S, Hsu JY, Simon TA, Wu Q, Xie F, Yang S, Curtis JR (2019) Timing of abatacept before elective arthroplasty and risk of postoperative outcomes. Arthritis Care Res (Hoboken) 71(9):1224–1233. https://doi.org/10.1002/acr.23843

    Article  CAS  PubMed Central  Google Scholar 

  36. Godot S, Gottenberg JE, Paternotte S, Pane I, Combe B, Sibilia J, Flipo RM, Schaeverbeke T, Ravaud P, Toussirot E, Berenbaum F, Mariette X, Wendling D, Sellam J (2013) Safety of surgery after rituximab therapy in 133 patients with rheumatoid arthritis: data from the autoimmunity and rituximab registry. Arthritis Care Res (Hoboken) 65(11):1874–1879. https://doi.org/10.1002/acr.22056

    Article  CAS  Google Scholar 

  37. Md Yusof MY, Vital EM, McElvenny DM, Hensor EMA, Das S, Dass S, Rawstron AC, Buch MH, Emery P, Savic S (2019) Predicting severe infection and effects of hypogammaglobulinemia during therapy with rituximab in rheumatic and musculoskeletal diseases. Arthritis Rheumatol 71(11):1812–1823. https://doi.org/10.1002/art.40937

    Article  CAS  PubMed  Google Scholar 

  38. Kneitz C, Krüger K (2021) Infektionsprophylaxe bei rheumatologischen Erkrankungen. Z Rheumatol 80(2):149–157. https://doi.org/10.1007/s00393-020-00938-5

    Article  PubMed  Google Scholar 

  39. Hanitsch L, Baumann U, Boztug K et al (2019) S3-Leitlinie 18-001: Therapie primärer Antikörpermangelerkrankungen. www.awmf.org/uploads/tx_szleitlinien/189-001l. Zugegriffen: 1. Sept. 2021

  40. Morel J, Locci M, Banal F, Combe B, Cormier G, Dougados M, Flipo RM, Marcelli C, Pham T, Rist S, Solau GE, Sibilia J, Lukas C (2020) Safety of surgery in patients with rheumatoid arthritis treated with tocilizumab: data from the French (REGistry-RoAcTEmra) Regate registry. Clin Exp Rheumatol 38(3):405–410

    PubMed  Google Scholar 

  41. Hirao M, Hashimoto J, Tsuboi H, Nampei A, Nakahara H, Yoshio N, Mima T, Yoshikawa H, Nishimoto N (2009) Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab. Ann Rheum Dis 68(5):654–657. https://doi.org/10.1136/ard.2008.090068

    Article  CAS  PubMed  Google Scholar 

  42. Nishida K, Harada R, Nasu Y, Takeshita A, Nakahara R, Natsumeda M, Ozaki T (2018) The clinical course of patients with rheumatoid arthritis who underwent orthopaedic surgeries under disease control by tofacitinib. Mod Rheumatol 28(6):1063–1065. https://doi.org/10.1080/14397595.2018.1427431

    Article  PubMed  Google Scholar 

  43. Lightner AL, Vaidya P, Holubar S, Warusavitarne J, Sahnan K, Carrano FM, Spinelli A, Zaghiyan K, Fleshner PR (2021) Perioperative safety of tofacitinib in surgical ulcerative colitis patients. Colorectal Dis 23(8):2085–2090. https://doi.org/10.1111/codi.15702

    Article  CAS  PubMed  Google Scholar 

  44. Ketfi C, Boutigny A, Mohamedi N, Bouajil S, Magnan B, Amah G, Dillinger JG (2021) Risk of venous thromboembolism in rheumatoid arthritis. Joint Bone Spine 88(3):105122. https://doi.org/10.1016/j.jbspin.2020.105122

    Article  CAS  PubMed  Google Scholar 

  45. Gualtierotti R, Parisi M, Ingegnoli F (2018) Perioperative management of patients with inflammatory rheumatic diseases undergoing major orthopaedic surgery: a practical overview. Adv Ther 35(4):439–456. https://doi.org/10.1007/s12325-018-0686-0

    Article  PubMed  PubMed Central  Google Scholar 

  46. Emery P, Tanaka Y, Cardillo T, Schlichting D, Rooney T, Beattie S, Helt C, Smolen JS (2020) Temporary interruption of baricitinib: characterization of interruptions and effect on clinical outcomes in patients with rheumatoid arthritis. Arthritis Res Ther 22(1):115. https://doi.org/10.1186/s13075-020-02199-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Cordtz R, Odgaard A, Kristensen LE, Overgaard S, Dreyer L (2020) Risk of medical complications following total hip or knee arthroplasty in patients with rheumatoid arthritis: a register-based cohort study from Denmark. Semin Arthritis Rheum 50(1):30–35. https://doi.org/10.1016/j.semarthrit.2019.06.007

    Article  PubMed  Google Scholar 

  48. Richardson SS, Kahlenberg CA, Goodman SM, Russell LA, Sculco TP, Sculco PK, Figgie MP (2019) Inflammatory arthritis is a risk factor for multiple complications after total hip arthroplasty: a population-based comparative study of 68,348 patients. J Arthroplasty 34(6):1150–1154.e2. https://doi.org/10.1016/j.arth.2019.02.018

    Article  PubMed  Google Scholar 

  49. Nystad TW, Fenstad AM, Furnes O, Havelin LI, Skredderstuen AK, Fevang BT (2016) Reduction in orthopaedic surgery in patients with rheumatoid arthritis: a Norwegian register-based study. Scand J Rheumatol 45(1):1–7. https://doi.org/10.3109/03009742.2015.1050451

    Article  CAS  PubMed  Google Scholar 

  50. Gogna R, Cheung G, Arundell M, Deighton C, Lindau TR (2015) Rheumatoid hand surgery: is there a decline? A 22-year population-based study. Hand (N Y) 10(2):272–278. https://doi.org/10.1007/s11552-014-9708-9

    Article  Google Scholar 

  51. Cordtz R, Hawley S, Prieto-Alhambra D, Hojgaard P, Zobbe K, Kristensen LE, Overgaard S, Odgaard A, Soussi BG, Dreyer L (2020) Reduction in upper limb joint surgery among rheumatoid arthritis patients: an interrupted time-series analysis using Danish health care registers. Arthritis Care Res (Hoboken) 72(2):274–282. https://doi.org/10.1002/acr.23835

    Article  Google Scholar 

  52. Cordtz RL, Hawley S, Prieto-Alhambra D, Hojgaard P, Zobbe K, Overgaard S, Odgaard A, Kristensen LE, Dreyer L (2018) Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time-series analysis using nationwide Danish healthcare registers. Ann Rheum Dis 77(5):684–689. https://doi.org/10.1136/annrheumdis-2017-212424

    Article  PubMed  Google Scholar 

  53. Matsumoto T, Nishino J, Izawa N, Naito M, Hirose J, Tanaka S, Yasui T, Saisho K, Tohma S (2017) Trends in treatment, outcomes, and incidence of orthopedic surgery in patients with rheumatoid arthritis: an observational cohort study using the Japanese national database of rheumatic diseases. J Rheumatol 44(11):1575–1582. https://doi.org/10.3899/jrheum.170046

    Article  PubMed  Google Scholar 

  54. Guldberg-Moller J, Cordtz RL, Kristensen LE, Dreyer L (2019) Incidence and time trends of joint surgery in patients with psoriatic arthritis: a register-based time series and cohort study from Denmark. Ann Rheum Dis 78(11):1517–1523. https://doi.org/10.1136/annrheumdis-2019-215313

    Article  PubMed  Google Scholar 

  55. Taylor-Williams O, Nossent J, Inderjeeth CA (2020) Incidence and complication rates for total hip arthroplasty in rheumatoid arthritis: a systematic review and meta-analysis across four decades. Rheumatol Ther. https://doi.org/10.1007/s40744-020-00238-z

    Article  PubMed  PubMed Central  Google Scholar 

  56. Abou Zahr Z, Spiegelman A, Cantu M, Ng B (2015) Perioperative use of anti-rheumatic agents does not increase early postoperative infection risks: a veteran affairs’ administrative database study. Rheumatol Int 35(2):265–272. https://doi.org/10.1007/s00296-014-3121-0

    Article  CAS  PubMed  Google Scholar 

  57. Goodman SM, Bykerk VP, DiCarlo E, Cummings RW, Donlin LT, Orange DE, Hoang A, Mirza S, McNamara M, Andersen K, Bartlett SJ, Szymonifka J, Figgie MP (2018) Flares in patients with rheumatoid arthritis after total hip and total knee arthroplasty: rates, characteristics, and risk factors. J Rheumatol 45(5):604–611. https://doi.org/10.3899/jrheum.170366

    Article  PubMed  Google Scholar 

  58. Goodman SM, Mirza SZ, DiCarlo EF, Pearce-Fisher D, Zhang M, Mehta B, Donlin LT, Bykerk VP, Figgie MP, Orange DE (2020) Rheumatoid arthritis flares after total hip and total knee arthroplasty: outcomes at one year. Arthritis Care Res (Hoboken) 72(7):925–932. https://doi.org/10.1002/acr.24091

    Article  Google Scholar 

  59. Carlson VR, Anderson LA, Lu CC, Sauer BC, Blackburn BE, Gililland JM (2021) Perioperative continuation of biologic medications increases odds of periprosthetic joint infection in patients with inflammatory arthropathy. J Arthroplasty 36(7):2546–2550. https://doi.org/10.1016/j.arth.2021.02.025

    Article  PubMed  Google Scholar 

  60. Mangold DR, Wagner ER, Cofield RH, Sanchez-Sotelo J, Sperling JW (2019) Reverse shoulder arthroplasty for rheumatoid arthritis since the introduction of disease-modifying drugs. Int Orthop 43(11):2593–2600. https://doi.org/10.1007/s00264-019-04373-3

    Article  PubMed  Google Scholar 

  61. Dougherty CD, Hung YY, Weintraub MLR, Patel S, King CM (2019) Osseous and soft tissue complications associated with foot and ankle surgery in patients with rheumatoid arthritis taking a variety of antirheumatic medications. J Foot Ankle Surg 58(3):508–513. https://doi.org/10.1053/j.jfas.2018.09.030

    Article  PubMed  Google Scholar 

  62. Koyama K, Ohba T, Ebata S, Haro H (2016) Postoperative surgical infection after spinal surgery in rheumatoid arthritis. Orthopedics 39(3):e430–433. https://doi.org/10.3928/01477447-20160404-05

    Article  PubMed  Google Scholar 

  63. Klifto KM, Cho BH, Lifchez SD (2020) The management of perioperative immunosuppressant medications for rheumatoid arthritis during elective hand surgery. J Hand Surg Am 45(8):779.e1–779.e6. https://doi.org/10.1016/j.jhsa.2020.02.005

    Article  Google Scholar 

  64. Dalle Ore CL, Ames CP, Deviren V, Lau D (2019) Perioperative outcomes associated with thoracolumbar 3‑column osteotomies for adult spinal deformity patients with rheumatoid arthritis. J Neurosurg Spine 30(6):822–832. https://doi.org/10.3171/2018.11.SPINE18927

    Article  PubMed  Google Scholar 

  65. Elia CJ, Brazdzionis J, Toor H, Takayanagi A, Hariri O, Asgarzadie F, Rao S, Guppy K, Tashjian V (2020) Impact of chronic DMARD therapy in patients with rheumatoid arthritis undergoing surgery of the craniovertebral junction: a multi-center retrospective study. Spine (Phila Pa 1976) 45(13):930–936. https://doi.org/10.1097/BRS.0000000000003402

    Article  Google Scholar 

  66. Joo P, Ge L, Mesfin A (2020) Surgical management of the lumbar spine in rheumatoid arthritis. Global Spine J 10(6):767–774. https://doi.org/10.1177/2192568219886267

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Klaus Krüger.

Ethics declarations

Interessenkonflikt

K. Albrecht, D. Poddubnyy, J. Leipe, P. Sewerin, C. Iking-Konert, R. Scholz und K. Krüger geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Alle Autoren schreiben für die Kommission Pharmakotherapie der Deutschen Gesellschaft für Rheumatologie e. V. (DGRh) und den Vorstand der DGRh.

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Albrecht, K., Poddubnyy, D., Leipe, J. et al. Perioperativer Umgang mit der Therapie von Patienten mit entzündlich rheumatischen Erkrankungen. Z Rheumatol 81, 212–224 (2022). https://doi.org/10.1007/s00393-021-01140-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-021-01140-x

Schlüsselwörter

Keywords

Navigation