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Optimizing Perioperative Outcomes for Older Patients with Rheumatoid Arthritis Undergoing Arthroplasty: Emphasis on Medication Management

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Abstract

Patients with rheumatoid arthritis continue to undergo arthroplasty despite widespread use of potent disease-modifying drugs (DMARDs), including the biologic tumor necrosis-α inhibitors. In fact, over 80 % of RA patients are taking DMARDs or biologics at the time of arthroplasty. While many RA-specific factors including disease activity and disability may contribute to the increase in infection in RA patients undergoing arthroplasty, immunosuppressant medications may also play a role. As the age of patients with RA undergoing arthroplasty is rising, and the incidence of arthroplasty among the older population is increasing, optimal perioperative management of DMARDs and biologics in older patients with RA is an increasing challenge. Although evidence is sparse, most evidence supports withholding tumor necrosis-α inhibitors and other biologics prior to surgery based on the dosing interval, and continuing methotrexate and hydroxychloroquine through the perioperative period. There is no consensus regarding leflunomide, and rituximab risk does not appear related to the interval between infusion and surgery. This paper reviews arthroplasty outcomes including complications in patients with RA, and discusses the rationale for strategies for the optimal medication management of DMARDs and biologics in the perioperative period to minimize complications and improve outcomes.

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Acknowledgments

S. M. Goodman has no relevant conflicts of interest. No sources of funding were used to support the writing of this manuscript.

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  1. Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, USA

    Susan M. Goodman

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Goodman, S.M. Optimizing Perioperative Outcomes for Older Patients with Rheumatoid Arthritis Undergoing Arthroplasty: Emphasis on Medication Management. Drugs Aging 32, 361–369 (2015). https://doi.org/10.1007/s40266-015-0262-0

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