American College of Rheumatology – For Immediate Release, June 16, 2017
ATLANTA – According to a new guideline released by the American College of Rheumatology (ACR) and American Association of Hip and Knee Surgeons (AAHKS), the risk of joint infection resulting from total hip and knee replacements can be reduced with careful management of anti-rheumatic medications during the perioperative process. The guideline represents the first time rheumatologists and orthopaedic surgeons have collaborated to develop recommendations.
“Periprosthetic joint infection remains one of the most common reasons for failure of hip and knee replacement,” said Bryan D. Springer, MD, an orthopedic surgeon at the OrthoCarolina Hip and Knee Center in Charlotte, N.C., and AAHKS Education Council Chair, who served as a co-principal investigator for the guideline project. “Because periprosthetic joint infections are associated with such high morbidity and mortality, we felt there was a dire need for perioperative management recommendations that could be subscribed to by both disciplines in order to provide arthritis patients with better outcomes.”
The guideline includes eight recommendations regarding when to continue, withhold and re-start medications commonly used to treat inflammatory rheumatic diseases (e.g., rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus), as well as the optimal perioperative dosing of glucocorticoids. Key recommendations for reducing the risk of infection include:
- Discontinuing biologic therapy prior to surgery in patients with inflammatory arthritis.
- Withholding tofacitinib for at least seven days prior to surgery in rheumatoid arthritis, spondyloarthritis and juvenile idiopathic arthritis patients.
- Withholding rituximab and belimumab prior to surgery in all systemic lupus erythematosus patients undergoing arthroplasty.
In addition to rheumatology and orthopedic experts, a patient panel was incorporated to ensure the guidelines adequately represented patients’ concerns and preferences.