Rheumatologic disorders

ACR/AAHKS Release Guidelines on Antirheumatic Therapy For Patients Undergoing Joint Replacement

The American College of Rheumatology and the American Association of Hip and Knee Surgeons have released new guidelines on the management of antirheumatic medications in patients with rheumatic disease undergoing elective total knee or hip arthroplasty.

Specifically, the guidelines detail management of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA), juvenile idiopathic arthritis (JIA), and systemic lupus erythematosus (SLE).
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The guidelines include 7 recommendations based on low- or moderate-quality evidence. Among the recommendations:

  • Patients receiving non-biologic disease-modifying antirheumatic drugs who are undergoing elective total knee or hip arthroplasty should continue their current dose of methotrexate, leflunomide, hydroxychloroquine, or sulfasalazine.
  • Biologic medications, including adalimumab and etanercept, should be withheld for roughly 1 dosing schedule before patients undergo surgery.
  • Restart biologic therapy in patients from whom it was withheld prior to surgery once wounds show evidence of healing.

“The recommendations provide important guidance  that  was  informed  by  the  available  literature, clinical expertise and experience, and patient values and preferences. The acknowledgment of low-quality evidence in this area should lay the foundation for future research,” the researchers concluded.

—Michael Potts

Reference:

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 19, 2017]. Arthritis Care & Research. doi: 10.1002/acr.23274.