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Perioperative complications in elective surgery in patients with rheumatoid arthritis treated with biologics

  • Original Article
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Modern Rheumatology

Abstract

We retrospectively investigated the influence of biological agents on delayed wound healing and the occurrence of postoperative surgical site infection (SSI) in patients after surgery for rheumatoid arthritis. The patients were divided into two groups—those with and without treatment with biological agents (276 and 278 joints, respectively)—and adverse events (delay in wound healing and SSI) were investigated. Wound healing was delayed in 11.4% of total knee arthroplasty (TKA) operations, 16.7% of total ankle arthroplasty operations, and 9.7% of foot surgeries in the treatment group, and in 5.5% of TKA operations, 12.5% of total elbow arthroplasty operations, and 5.7% of foot surgeries in the non-treatment group. The difference in the incidence of delayed wound healing between the two groups was not statistically significant. In the treatment group, postoperative superficial and deep infection developed in one and two joints, respectively. In the non-treatment group, superficial infection developed in one joint. There was no statistically significant difference between the two groups. These findings suggest that the use of biological agents may not affect the incidence of postoperative adverse events related to wound healing and SSI.

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References

  1. Matsuno H, Yudoh K, Katayama R, Nakazawa F, Uzuki M, Sawai T, et al. The role of TNF-α in the pathogenesis of inflammation and joint destruction in rheumatoid arthritis (RA): a study using a human RA/SCID mouse chimera. Rheumatology. 2002;41:329–37.

    Article  PubMed  CAS  Google Scholar 

  2. Musacchio E, Valvason C, Botsios C, Ostuni F, Furlan A, Ramonda R, et al. The tumor necrosis factor-α blocking agent infliximab inhibits interleukin 1beta (IL-1beta) and IL-6 gene expression in human osteoblastic cells. J Rheumatol. 2009;36:1575–9.

    Article  PubMed  CAS  Google Scholar 

  3. Kudo O. Interleukin-6 and interleukin-11 support human osteoclast formation by a RANKL-independent mechanism. Bone. 2003;32:1–7.

    Article  PubMed  CAS  Google Scholar 

  4. Takeuchi T, Yamanaka H, Inoue E, Nagasawa H, Nawata M, Ikari K, et al. Retrospective clinical study on the notable efficacy and related factors of infliximab therapy in a rheumatoid arthritis management group in Japan: one-year outcome of joint destruction (RECONFIRM-2J). Mod Rheumatol. 2008;18:447–54.

    Article  PubMed  CAS  Google Scholar 

  5. Takeuchi T, Miyasaka N, Inoue K, Abe T, Koike T. Impact of trough serum level on radiographic and clinical response to infliximab plus methotrexate in patients with rheumatoid arthritis: results from the RISING study. Mod Rheumatol. 2009;19:478–87.

    Article  PubMed  CAS  Google Scholar 

  6. Scanzello CR, Figgie MP, Nestor BJ, Goodman SM. Perioperative management of medications used in the treatment of rheumatoid arthritis. HSS J. 2006;2:141–7.

    Article  PubMed  Google Scholar 

  7. Fu X, Tian H, Hsu S, Wang D, Sheng Z. In vivo effects of tumor necrosis factor-α on incised wound and gunshot wound healing. J Trauma. 1996;40:140–3.

    Article  Google Scholar 

  8. Giles JT, Bartlett SJ, Gelber AC, Nanda S, Fontaine K, Ruffing V, et al. Tumor necrosis factor inhibitor therapy and risk of serious postoperative orthopedic infection in rheumatoid arthritis. Arthritis Rheum. 2006;55:333–7.

    Article  PubMed  Google Scholar 

  9. Bibbo C, Goldberg JW. Infectious and healing complications after elective orthopaedic foot and ankle surgery during tumor necrosis factor-alpha inhibition therapy. Foot Ankle Int. 2004;25:331–5.

    PubMed  Google Scholar 

  10. Den Broeder AA, Creemers MC, Fransen J, de Jong E, de Rooij DJ, Wymenga A, et al. 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. 2007;3:689–95.

    Google Scholar 

  11. Ruyssen-Witrand A, Gossec L, Salliot C, Luc M, Duclos M, Guignard S, et al. Complication rates of 127 surgical procedures performed in rheumatic patients receiving tumor necrosis factor alpha blockers. Clin Exp Rheumatol. 2007;25:430–6.

    PubMed  CAS  Google Scholar 

  12. Guidelines of TNF inhibition therapy for rheumatoid arthritis (RA) (revised edition). Japan College of Rheumatology.

  13. Adalimumab treatment guidelines for rheumatoid arthritis (RA). Japan College of Rheumatology.

  14. Tocilizumab treatment guidelines for rheumatoid arthritis (RA) (2010 revised edition). Japan College of Rheumatology.

  15. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20:250–78.

    Article  PubMed  CAS  Google Scholar 

  16. Mori R, Kondo T, Ohshima T, Ishida Y, Mukaida N. Accelerated wound healing in tumor necrosis factor receptor p55-deficient mice with reduced leukocyte infiltration. FASEB J. 2002;16:963–74.

    Article  PubMed  CAS  Google Scholar 

  17. Alves-Rosa MF, Palermo MS, Isturiz MA. Enhancement of immune complex clearance by TNF-alpha in a murine model. Clin Immunol Immunopathol. 1998;89:214–21.

    Article  PubMed  CAS  Google Scholar 

  18. Gallucci RM, Simeonova PP, Matheson JM, Kommineni C, Guriel JL, Sugawara T, Luster MI. Impaired cutaneous wound healing in interleukin-6-deficient and immunosuppressed mice. FASEB J. 2000;14:2525–31.

    Article  PubMed  CAS  Google Scholar 

  19. Kawakami K, Ikari K, Kawamura K, Tsukahara S, Iwamoto T, Yano K, et al. Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-alpha blockers: perioperative interruption of tumour necrosis factor-alpha blockers decreases complications? Rheumatology (Oxford). 2010;49:341–7.

    Article  CAS  Google Scholar 

  20. Ledingham J, Deighton C. Update on the British Society for Rheumatology guidelines for prescribing TNF alpha blockers in adults with rheumatoid arthritis (update of previous guidelines of April 2001). Rheumatology (Oxford). 2005;44:157–63.

    Article  CAS  Google Scholar 

  21. Nederlandse Vereniging voor Reumatologie. Medicijnen: het toepassen van TNF blockade in de behandeling vav reumatoide arthritis. Utrecht: Dutch Society for Rheumatology; 2003.

    Google Scholar 

  22. Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762–84.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Ayako Kubota.

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Kubota, A., Nakamura, T., Miyazaki, Y. et al. Perioperative complications in elective surgery in patients with rheumatoid arthritis treated with biologics. Mod Rheumatol 22, 844–848 (2012). https://doi.org/10.1007/s10165-012-0612-2

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  • DOI: https://doi.org/10.1007/s10165-012-0612-2

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