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Rheumatology International

, Volume 32, Issue 1, pp 5–13 | Cite as

Should anti-TNF therapy be discontinued in rheumatoid arthritis patients undergoing elective orthopaedic surgery? A systematic review of the evidence

  • Leslie GohEmail author
  • Teresa Jewell
  • Catherine Laversuch
  • Ash Samanta
Review Article

Abstract

Anti-tumour necrosis factor (TNF) therapies have revolutionized the management of rheumatoid arthritis (RA). A high proportion of RA patients are now established users of anti-TNF agents. Unfortunately, many RA patients with longstanding disease still require elective orthopaedic procedures. Published studies on the influence of TNF antagonist on infection rates in RA patients undergoing surgery are conflicting. However, national registries of RA patients on anti-TNF reported an increased risk of infection. The risk of anti-TNF-related infection is highest at the start of treatment with frequent involvement of the skin and subcutaneous tissue. Infection at these sites could negatively influence the healing of surgical wound. Current guidelines suggest that treatment with biologics should be discontinued prior to surgery. Patients with established disease are more likely to flare compared to those with early disease on stopping treatment. Consequently, TNF blockers need to be reinstated promptly after surgery to avoid the risk of RA flare.

Keywords

Rheumatoid arthritis Anti-TNF Infections Orthopaedic surgery 

Notes

Acknowledgments

The authors are grateful to the librarians at Musgrove Park Hospital for their assistance in retrieving articles for this project.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Leslie Goh
    • 1
    Email author
  • Teresa Jewell
    • 1
  • Catherine Laversuch
    • 1
  • Ash Samanta
    • 2
  1. 1.Department of RheumatologyMusgrove Park HospitalTaunton, SomersetUK
  2. 2.Department of RheumatologyUniversity Hospitals of Leicester NHS Trust, Leicester Royal InfirmaryLeicesterUK

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