Guidelines for Peri-Op Care in Rheumatic Disease

HealthDay News — Guidelines have been developed for perioperative management of antirheumatic drug therapy in patients with rheumatic diseases undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA); the guidelines were published online June 16 in Arthritis Care & Research.

Susan M. Goodman, MD, from the Hospital for Special Surgery/Weill Cornell Medicine in New York City, and colleagues developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy. They conducted a multistep systematic literature review, and synthesized evidence for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management.

The guidelines address perioperative use of antirheumatic drug therapy for adults with rheumatoid arthritis, spondyloarthritis, juvenile idiopathic arthritis, or systemic lupus erythematosus undergoing elective THA or TKA. Recommendations were provided on when to continue, withhold, and restart antirheumatic drug therapy, including traditional disease modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids. Seven recommendations were included, which were conditional and based on low- or moderate-quality evidence. The recommendations include continuing DMARDs during the perioperative period, while withholding biologic medications prior to surgery and restarting after evidence of wound healing.

“This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA,” the authors wrote. “These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.”

Several authors disclosed financial ties to the pharmaceutical industry.


Goodman SM, Springer B, Guyatt G, et al. 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 [published online June 22, 2017]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23274