Patient with Rheumatic Disease Undergoing Surgery: Handling of Antirheumatic Agents in the Perioperative Period
DOI:
https://doi.org/10.25751/rspa.17927Keywords:
Antirheumatic Agents; Perioperative Care; Perioperative PeriodAbstract
Inflammatory rheumatic diseases are functional disorders of the musculoskeletal system whose signs and symptoms are inflammatory. Progressive and chronic situations that require surgery, especially orthopedic surgery, total hip and/or knee arthroplasty, are exposed to a high risk of surgical wound infection, aggravated by immunosuppressive treatment with antirheumatic drugs to which these patients are submitted. The aim of this article is to summarize the most recent and available evidence on perioperative management of these drugs in patients proposed for surgery, their maintenance versus suspension in the preoperative period and their resumption in the postoperative.
A narrative literature review was conducted with the terms “antirheumatic agents/perioperative management”, “disease modifying antirheumatic drugs” and “rheumatic disease/postoperative adverse events” in different electronic data bases such as: MEDLINE, EMBASE, Cochrane Library and SciELo. We included articles in Portuguese and English, according to pre-defined selection criteria. Continuation of methotrexate, leflunomide, sulfasalazine and hydroxychloroquine in patients with inflammatory rheumatic diseases appears to be safe in the preoperative period. In severe systemic lupus erythematosus, azathioprine, cyclosporine A, tacrolimus and mycophenolate mofetil should be maintained and its suspension one week before surgery should only be done in situations of non-serious systemic lupus erythematosus. Tofacitinib should also be discontinued for one week prior to the surgical procedure and therapy should be resumed 3 to 5 days postoperatively, in the absence of complications of the surgical wound. For biological agents, the preoperative withdrawal time depends on the drug dosing cycle, therefore surgery should be planned for the end of each therapeutic cycle. Restarting should be done when the surgical wound shows signs of healing and there is no evidence of infection, usually on the 14th postoperative day. The literature on the perioperative management of antirheumatic drugs is scarce. Continuing therapy may hamper wound healing and predispose to infections and discontinuation may induce a flare of the disease, which may increase the need for corticosteroids for control and limit mobilization and rehabilitation after surgery. Due to the associated risks and to improve all perioperative care of the patient, an effective communication between the anesthesiologist and the rheumatologist and more scientific evidence on the subject are imperative.
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References
1. Branco JC, Rodrigues AM, Gouveia N, Eusébio M, Ramiro S, Machado PM, et al. EpiReumaPt – Um sonho antigo, uma necessidade atual. Médico News. 2015:6-9.
2. Mertelsmann-Voss C, Lyman S, Pan TH, Goodman SM, Figgie MP, Mandl LA. US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis. Arthritis Rheum. 2014;66:1432-9.
3. Nikiphorou E, Carpenter L, Morris S, Macgregor AJ, Dixey J, Kiely P, et al. Hand and foot surgery rates in rheumatoid arthritis have declined from 1986 to 2011, but large-joint replacement rates remain unchanged: results from two UK inception cohorts. Arthritis Rheum. 2014;66:1108-9.
4. Mertelsmann-Voss C, Lyman S, Pan TJ, Goodman S, Figgie MP, Mandl LA. Arthroplasty rates are increased among US patients with systemic lupus erythematosus:1991-2005. J Rheumatol. 2014;41:867-74.
5. Au K, Reed G, Curtis JR, Kremer JM, Greenberg JD, Strand V, et al. High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70:785-91.
6. Gualtierotti R. Understanding cardiovascular risk in rheumatoid arthritis: still a long way to go. Atherosclerosis. 2017;256:123-4.
7. Ingegnoli F, Gualtierotti R, Artusi C, Lubrano E. Focus on the potential effects of treatments for spondylarthritides on cardiovascular risk. Expert Rev Clin Immunol. 2014;10:307-15.
8. Smolen JS, van der Heijde D, Machold KP, Aletaha D, Landew R. Proposal for a new nomenclature of disease-modifying antirheumatic drugs. Ann Rheum Dis. 2014;73:3-5.
9. Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76:960-77.
10. Smyth EM, FitzGerald GA. The eicosanoids: prostaglandins, thromboxanes, leukotrienes, & related compounds. In: Katzung BG, Trevor AJ, Masters SB, editors. Basic and clinical pharmacology. 13th ed. United States of America: McGraw-Hill Education-Europe Publisher; 2015. p 313-29.
11. Bird P, Griffiths H, Littlejohn G. Methotrexate in Rheumatoid Arthritis: Efficacy and Safety. J Pharmacovigil. 2014;2:8-11.
12. Bridges SL, López-Méndez A, Han KH, Tracy IC, Alarcón GS. Should methotrexate be discontinued before elective orthopaedic surgery in patients with rheumatoid arthritis? J Rheumatol. 1991;18:984-8.
13. Perhala RS, Wilke WS, Clough JD, Segal AM. Local infectious complications following large joint replacement in rheumatoid arthritis patients treated with methotrexate versus those not treated with methotrexate. Arthritis Rheum. 1991;34:146-52.
14. Jain A, Witbreuk M, Ball C, Nanchahal J. Influence of steroids and methotrexate on wound complications after elective rheumatoid hand and wrist surgery. J Hand Surg Am. 2002;27:449-55.
15. Sany J, Anaya JM, Canovas F, Combe B, Jorgensen C, Saker S, et al. Influence of methotrexate on the frequency of postoperative infectious complications in patients with rheumatoid arthritis. J Rheumatol. 1993;20:1129-32.
16. Grennan DM, Gray J, Loudon J, Fear S. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis. 2001;60:214-7.
17. Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, 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. Arthritis Rheum. 2017;69:1538-51.
18. Cutolo M, Bolosiu H, Perdriset G, LEADER Study Group. Efficacy and safety of leflunomide in DMARD-naive patients with early rheumatoid arthritis: comparison of a loading and a fixed-dose regimen. Rheumatology. 2013;52:1132-40.
19. Cannon GW, Kremer JM. Leflunomide. Rheum Dis Clin North Am. 2004;30:295-309.
20. Emery P, Breedveld FC, Lemmel EM, Kaltwasser JP, Dawes PT, Gömör B, et al. A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis. Rheumatology (Oxford). 2000;39:655-65.
21. Fuerst M, Möhl H, Baumgärtel K, Rüther W. Leflunomide increases the risk of early healing complications in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Rheumatol Int. 2006;26:1138-42.
22. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Examination of the risk of continuous leflunomide treatment on the incidence of infectious complications after joint arthroplasty in patients with rheumatoid arthritis. J Clin Rheumatol. 2003;9:115-8.
23. Ogrendik M. Antibiotics for the treatment of rheumatoid arthritis. Int J Gen Med. 2013;27:43-7.
24. Gaffo A, Saag KG, Curtis JR. Treatment of rheumatoid arthritis. Am J Health Syst Pharm. 2006;63:2451-65.
25. Feely MG, OʼDell JR. Update on the use of conventional disease-modifying antirheumatic drugs in the management of rheumatoid arthritis. Curr Opin Rheumatol. 2010;22:316-20.
26. Gibofsky A. Combination Therapy for Rheumatoid Arthritis in the Era of Biologicals. HSS J. 2006;2:30-41.
27. Rynes RI. Ophthalmologic safety of long-term hydroxychloroquine sulfate treatment. Am J Med. 1983;75:35-9.
28. Escalante A, Beardmore TD. Risk factors for early wound complications after orthopedic surgery for rheumatoid arthritis. J Rheumatol. 1995;22:1844-51.
29. Loudon JR. Hydroxychloroquine and postoperative thromboembolism after total hip replacement. Am J Med. 1988;85:57-61.
30. Muniz LF, Pereira RM, Silva TF, Bonfá E, Borba EF. Impact of therapy on metabolic syndrome in young adult premenopausal female lupus patients: beneficial effect of antimalarials. Arthritis Care Res (Hoboken). 2015;67:1255-62.
31. Fasano S, Margiotta DP, Navarini L, Pierro L, Pantano I, Riccardi A, et al. Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review. Lupus. 2017;26:1463-72.
32. Fasano S, Pierro L, Pantano I, Iudici M, Valentini G. Longterm hydroxychloroquine therapy and lowdose aspirin may have an additive effectiveness in the primary prevention of cardiovascular events in patients with systemic lupus erythematosus. J Rheumatol. 2017;44:1032-8.
33. Cronstein BN. Pharmacogenetics in the rheumatic diseases. Ann Rheum Dis. 2004;63:ii25-ii27.
34. Tavadia SM, Mydlarski PR, Reis MD, Mittmann N, Pinkerton PH, Shear N, et al. Screening for azathioprine toxicity: a pharmacoeconomic analysis based on a target case. J Am Acad Dermatol. 2000;42:628-32.
35. Busti AJ, Hooper JS, Amaya CJ, Kazi S. Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing. Pharmacotherapy. 2005;25:1566-91.
36. Colombel JF, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99:878-83.
37. Palmisano AC, Kuhn AW, Urquhart AG, Pour AE. Post-operative medical and surgical complications after primary total joint arthroplasty in solid organ transplant recipients: a case series. Int Orthop. 2017;41:13-9.
38. Klement MR, Penrose CT, Bala A, Wellman SS, Bolognesi MP, Seyler TM. How do previous solid organ transplant recipients fare after primary total knee arthroplasty? J Arthroplasty. 2016;31:609-615.e1.
39. Hardinger K, Magee CC. Pharmacology of cyclosporine and tacrolimus. UpToDate. Waltham, MA:UpToDate Inc.;2019 [consultado 2019 Abr 10]. Disponível em: http://www.uptodate.com/.
40. Friemann S, Feuring E, Padberg W, Ernst W. Improvement of nephrotoxicity, hypertension and lipid metabolism after conversion of kidney transplant recipients from cyclosporine to tacrolimus. Transplant Proc. 1998;30:1240-2.
41. Friemann S, Stopp K, Christ B, Weimer R, Padberg W, Ernst W. Conversion to tacrolimus in hyperlipidemic patients. Transplant Proc. 1999;31:41S-43S.
42. Thorp M, DeMattos A, Bennett W, Barry J, Norman D. The effect of conversion from cyclosporine to tacrolimus on gingival hyperplasia, hirsutism, cholesterol. Transplantation. 2000;69:1218-20.
43. Garcia SG, Lopes LS, Schott KL, Beck ST, Pomblum VJ. Ciclosporina A e tacrolimus: uma revisão. J Bras Patol Med Lab. 2004;40:393-401.
44. Mele TS, Halloran PF. The use of mycophenolate mofetil in transplant recipients. Immunopharmacology. 2000;47:215-45.
45. Sousa SR, Galante NZ, Barbosa DA, Pestana JO. Incidence of infectious complications and their risk factors in the fist year after renal transplantation. J Bras Nefrol. 2010;32:75-82.
46. Humar A, Ramcharan T, Denny R, Gillingham KJ, Payne WD, Matas AJ. Are wound complications after a kidney transplant more common with modern immunosuppression? Transplantation. 2001;72:1920-3.
47. Kremer JM, Bloom BJ, Breedveld FC, Coombs JH, Fletcher MP, Gruben D, et al. The safety and efficacy of a JAK inhibitor in patients with active rheumatoid arthritis: results of a double-blind, placebocontrolled phase IIa trial of three dosage levels of CP-690,550 versus placebo. Arthritis Rheum. 2009;60:1895-905.
48. European Medicines Agency. Um resumo sobre Xeljanz® (tofacitinib) e porque está autorizado na União Europeia. United Kingdom: European Medicines Agency, Science Medicines Health; 2018 Jun. EMA/353299/2018.
49. Food and Drug Administration. Highlights of prescribing information XELJANZ ® (tofacitinib). United States: Food and Drug Administration; 2016 Feb. Reference ID: 3891137.
50. Wollenhaupt J, Silverfield J, Lee EB, Curtis JR, Wood SP, Soma K, et al. Safety and effiacy of tofacitinib, an oral janus kinase inhibitor, for the treatment of rheumatoid arthritis in open-label, longterm extension studies. J Rheumatol. 2014;41:837-52.
51. Woodrick RS, Ruderman EM. Safety of biologic therapy in rheumatoid arthritis. Nat Rev Rheumatol. 2011;7:639-52.
52. Rubbert-Roth A. Assessing the safety of biologic agents in patients with rheumatoid arthritis. Rheumatology (Oxford). 2012;51:v38-47.
53. Goh L, Jewell T, Laversuch C, Samanta A. Should anti-TNF therapy be discontinued in rheumatoid arthritis patients undergoing elective orthopaedic surgery? A systematic review of the evidence. Rheumatol Int. 2012;32:5-13.
54. Härle P, Straub RH, Fleck M. Perioperative management of immunosuppression in rheumatic diseases-what to do? Rheumatol Int. 2010;30:999-1004.
55. Goodman SM, Paget S. Perioperative drug safety in patients with rheumatoid arthritis. Rheum Dis Clin North Am. 2012;38:747-59.
56. Jung YO, Kim HA. Recent Paradigm Shifts in the Diagnosis and Treatment of Rheumatoid Arthritis. Korean J Intern Med. 2012;27:378-87.
57. Williams RO, Feldmann M, Maini RN. Anti-tumor necrosis factor ameliorates joint disease in murine collagen-induced arthritis. Proc Natl Acad Sci U S A. 1992;89:9784-8.
58. Hirano Y, Kojima T, Kanayama Y, Shioura T, Hayashi M, Kida D, et al. Influences of antitumour necrosis factor agents on postoperative recovery in patients with rheumatoid arthritis. Clin Rheumatol. 2010;29:495-500.
59. Johnson BK, Goodman SM, Alexiades MM, Figgie MP, Demmer RT, Mandl LA. Patterns and associated risk of perioperative use of anti tumor necrosis factor in patients with rheumatoid arthritis undergoing total knee replacement. J Rheumatol 2013;40:617-23.
60. 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.
61. Maini RN, Feldmann M. How does infliximab work in rheumatoid arthritis? Arthritis Res. 2002;4:S22-8.
62. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58:826-50.
63. Haraoui B, Bykerk V. Etanercept in the treatment of rheumatoid arthritis. Ther Clin Risk Manag. 2007;3:99-105.
64. Korkina L, Trakhtman P, De Luca C, Leoni L, Raskovic D, Pastore S. Efficacy and safety of biologicals against immune-mediated diseases: do benefits outweigh risks? Drugs Today (Barc). 2010;46:119-36.
65. Mössner R, Schön MP, Reich K. Tumor necrosis factor antagonists in the therapy of psoriasis. Clin Dermatol. 2008;26:486-502.
66. European Medicines Agency. European public assessment report for Enbrel® (etanercept) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2014 Jul. EMA/398383/2014.
67. Furst DE, Ulrich RW, Prakash S. Nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, nonopioid analgesics & drugs used in gout. In: Katzung BG, Trevor AJ, Masters SB, editors. Basic and clinical pharmacology. 12th ed. United States of America: McGraw-Hill Education-Europe Publisher; 2012. p 635-57.
68. Kukar M, Petryna O, Efthimiou P. Biological targets in the treatment of rheumatoid arthritis: a comprehensive review of current and in-development biological disease modifying anti-rheumatic drugs. Biologics. 2009;3:443-57.
69. European Medicines Agency. European public assessment report for Humira® (adalimumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2017 Sep. EMA/518634/2017.
70. Deeks ED. Certolizumab pegol: a review of its use in the management of rheumatoid arthritis. Drugs. 2013;73:75-97.
71. Goel N, Stephens S. Certolizumab pegol. MAbs. 2010;2:137-47.
72. European Medicines Agency. European public assessment report for Cimzia® (certolizumab pegol) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2018 Sep. EMA/326020/2018.
73. European Medicines Agency. European public assessment report for Simponi® (golimumab) product information. United Kingdom: European Medicines Agency, Science Medicines Health; 2019 Mar. EMEA/H/C/000992-X/0083/G.
74. European Medicines Agency. European public assessment report for Simponi® (golimumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2019 Feb. EMA/552/2019.
75. Law V, Knox C, Djoumbou Y, Jewison T, Guo AC, Liu Y, et al. DrugBank 4.0: shedding new light on drug metabolism. Nucleic Acids Res. 2014;42:D1091-7.
76. European Medicines Agency. European public assessment report for Kineret® (anakinra) medicine overview. United Kingdom: European Medicines Agency, Science Medicines Health; 2018 Apr. EMA/155197/2018.
77. Howe CR, Gardner GC, Kadel NJ. Perioperative medication management for the patient with rheumatoid arthritis. J Am Acad Orthop Surg. 2006;14:544-51.
78. Mushtaq S, Goodman SM, Scanzello CR. Perioperative management of biologic agents used in treatment of rheumatoid arthritis. Am J Ther. 2011;18:426-34.
79. Hennigan S, Kavanaugh A. Interleukin-6 inhibitors in the treatment of rheumatoid arthritis. Ther Clin Risk Manag. 2008;4:767-75.
80. European Medicines Agency. European public assessment report for RoActemra® (tocilizumab) medicine overview. United Kingdom: European Medicines Agency, Science Medicines Health; 2018 Jul. EMA/490275/2018.
81. Momohara S, Hashimoto J, Tsuboi H, Miyahara H, Nakagawa N, Kaneko A, et al. Analysis of perioperative clinical features and complications after orthopaedic surgery in rheumatoid arthritis patients treated with tocilizumab in a real-world setting: results from the multicentre Tocilizumab in Perioperative Period (TOPP) study. Mod Rheumatol. 2013;23:440-9.
82. Hirao M, Hashimoto J, Tsuboi H, Nampei A, Nakahara H, Yoshio N, et al. Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab. Ann Rheum Dis. 2009;68:654-7.
83. Shah K, Lee WW, Lee SH, Kim SH, Kang SW, Craft J, et al. Dysregulated balance of Th17 and Th1 cells in systemic lupus erythematosus. Arthritis Res Ther. 2010;12:R53.
84. Menter A. The status of biologic therapies in the treatment of moderate to severe psoriasis. Cutis. 2009;84:14-24.
85. Rozenblit M, Lebwohl M. New biologics for psoriasis and psoriatic arthritis. Dermatol Ther. 2009;22:56-60.
86. European Medicines Agency. European public assessment report for Stelara® (ustekinumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2016 Oct. EMA/636854/2016.
87. Shim HH, Ma C, Kotze PG, Seow CH, Al-Farhan H, Al-Darmaki AK, et al. Preoperative ustekinumab treatment is not associated with increased postoperative complications in Crohn’s disease: a Canadian multi-centre observational cohort study. J Can Assoc Gastroenterol. 2018;1:115-23.
88. Lightner AL, McKenna NP, Tse CS, Hyman N, Smith R, Ovsepyan G, et al. Postoperative outcomes in ustekinumab-treated patients undergoing abdominal operations for Crohn’s disease. J Crohns Colitis. 2018;12:402-7.
89. Marinoni B, Ceribelli A, Massarotti MS, Selmi C. Th17 axis in psoriatic disease: pathogenetic and therapeutic implications. Auto Immun Highlights. 2014;5:9-19.
90. European Medicines Agency. European public assessment report for Cosentyx® (secukinumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2015 Nov. EMA/780949/2015.
91. European Medicines Agency. European public assessment report for Orencia® (abatacept) product information. United Kingdom: European Medicines Agency, Science Medicines Health; 2019 Mar. EMEA/H/C/000701-IG/1059.
92. Nishida K, Nasu Y, Hashizume K, Nakahara R, Ozawa M, Harada R, et al. Abatacept management during the perioperative period in patients with rheumatoid arthritis: report on eight orthopaedic procedures. Mod Rheumatol. 2014;24:544-5.
93. Latourte A, Gottenberg JE, Luxembourger C, Pane I, Claudepierre P, Richette P, et al. Safety of surgery in patients with rheumatoid arthritis treated by abatacept: data from the French Orencia in Rheumatoid Arthritis Registry. Rheumatology (Oxford). 2017;56:629-37.
94. Cohen SB, Emery P, Greenwald MW, Dougados M, Furie RA, Genovese MC, et al. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthritis Rheum. 2006;54:2793-806.
95. Mok CC. Rituximab for the treatment of rheumatoid arthritis: an update. Drug Des Devel Ther. 2014;8:87-100.
96. European Medicines Agency. European public assessment report for MabThera® (rituximab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2016 Jun. EMA/424820/2016.
97. Godot S, Gottenberg JE, Paternotte S, Pane I, Combe B, Sibilia J, et al. Safety of surgery after rituximab therapy in 133 patients with rheumatoid arthritis: data from the autoimmunity and rituximab registry. Arthritis Care Res (Hoboken). 2013;65:1874-9.
98. Cancro MP, D'Cruz DP, Khamashta MA. The role of B lymphocyte stimulator (BLyS) in systemic lupus erythematosus. J Clin Invest. 2009;119:1066-73.
99. European Medicines Agency. European public assessment report for Benlysta® (belimumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2017 Nov. EMA/676149/2017.
2. Mertelsmann-Voss C, Lyman S, Pan TH, Goodman SM, Figgie MP, Mandl LA. US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis. Arthritis Rheum. 2014;66:1432-9.
3. Nikiphorou E, Carpenter L, Morris S, Macgregor AJ, Dixey J, Kiely P, et al. Hand and foot surgery rates in rheumatoid arthritis have declined from 1986 to 2011, but large-joint replacement rates remain unchanged: results from two UK inception cohorts. Arthritis Rheum. 2014;66:1108-9.
4. Mertelsmann-Voss C, Lyman S, Pan TJ, Goodman S, Figgie MP, Mandl LA. Arthroplasty rates are increased among US patients with systemic lupus erythematosus:1991-2005. J Rheumatol. 2014;41:867-74.
5. Au K, Reed G, Curtis JR, Kremer JM, Greenberg JD, Strand V, et al. High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70:785-91.
6. Gualtierotti R. Understanding cardiovascular risk in rheumatoid arthritis: still a long way to go. Atherosclerosis. 2017;256:123-4.
7. Ingegnoli F, Gualtierotti R, Artusi C, Lubrano E. Focus on the potential effects of treatments for spondylarthritides on cardiovascular risk. Expert Rev Clin Immunol. 2014;10:307-15.
8. Smolen JS, van der Heijde D, Machold KP, Aletaha D, Landew R. Proposal for a new nomenclature of disease-modifying antirheumatic drugs. Ann Rheum Dis. 2014;73:3-5.
9. Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76:960-77.
10. Smyth EM, FitzGerald GA. The eicosanoids: prostaglandins, thromboxanes, leukotrienes, & related compounds. In: Katzung BG, Trevor AJ, Masters SB, editors. Basic and clinical pharmacology. 13th ed. United States of America: McGraw-Hill Education-Europe Publisher; 2015. p 313-29.
11. Bird P, Griffiths H, Littlejohn G. Methotrexate in Rheumatoid Arthritis: Efficacy and Safety. J Pharmacovigil. 2014;2:8-11.
12. Bridges SL, López-Méndez A, Han KH, Tracy IC, Alarcón GS. Should methotrexate be discontinued before elective orthopaedic surgery in patients with rheumatoid arthritis? J Rheumatol. 1991;18:984-8.
13. Perhala RS, Wilke WS, Clough JD, Segal AM. Local infectious complications following large joint replacement in rheumatoid arthritis patients treated with methotrexate versus those not treated with methotrexate. Arthritis Rheum. 1991;34:146-52.
14. Jain A, Witbreuk M, Ball C, Nanchahal J. Influence of steroids and methotrexate on wound complications after elective rheumatoid hand and wrist surgery. J Hand Surg Am. 2002;27:449-55.
15. Sany J, Anaya JM, Canovas F, Combe B, Jorgensen C, Saker S, et al. Influence of methotrexate on the frequency of postoperative infectious complications in patients with rheumatoid arthritis. J Rheumatol. 1993;20:1129-32.
16. Grennan DM, Gray J, Loudon J, Fear S. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis. 2001;60:214-7.
17. Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, 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. Arthritis Rheum. 2017;69:1538-51.
18. Cutolo M, Bolosiu H, Perdriset G, LEADER Study Group. Efficacy and safety of leflunomide in DMARD-naive patients with early rheumatoid arthritis: comparison of a loading and a fixed-dose regimen. Rheumatology. 2013;52:1132-40.
19. Cannon GW, Kremer JM. Leflunomide. Rheum Dis Clin North Am. 2004;30:295-309.
20. Emery P, Breedveld FC, Lemmel EM, Kaltwasser JP, Dawes PT, Gömör B, et al. A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis. Rheumatology (Oxford). 2000;39:655-65.
21. Fuerst M, Möhl H, Baumgärtel K, Rüther W. Leflunomide increases the risk of early healing complications in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Rheumatol Int. 2006;26:1138-42.
22. Tanaka N, Sakahashi H, Sato E, Hirose K, Ishima T, Ishii S. Examination of the risk of continuous leflunomide treatment on the incidence of infectious complications after joint arthroplasty in patients with rheumatoid arthritis. J Clin Rheumatol. 2003;9:115-8.
23. Ogrendik M. Antibiotics for the treatment of rheumatoid arthritis. Int J Gen Med. 2013;27:43-7.
24. Gaffo A, Saag KG, Curtis JR. Treatment of rheumatoid arthritis. Am J Health Syst Pharm. 2006;63:2451-65.
25. Feely MG, OʼDell JR. Update on the use of conventional disease-modifying antirheumatic drugs in the management of rheumatoid arthritis. Curr Opin Rheumatol. 2010;22:316-20.
26. Gibofsky A. Combination Therapy for Rheumatoid Arthritis in the Era of Biologicals. HSS J. 2006;2:30-41.
27. Rynes RI. Ophthalmologic safety of long-term hydroxychloroquine sulfate treatment. Am J Med. 1983;75:35-9.
28. Escalante A, Beardmore TD. Risk factors for early wound complications after orthopedic surgery for rheumatoid arthritis. J Rheumatol. 1995;22:1844-51.
29. Loudon JR. Hydroxychloroquine and postoperative thromboembolism after total hip replacement. Am J Med. 1988;85:57-61.
30. Muniz LF, Pereira RM, Silva TF, Bonfá E, Borba EF. Impact of therapy on metabolic syndrome in young adult premenopausal female lupus patients: beneficial effect of antimalarials. Arthritis Care Res (Hoboken). 2015;67:1255-62.
31. Fasano S, Margiotta DP, Navarini L, Pierro L, Pantano I, Riccardi A, et al. Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review. Lupus. 2017;26:1463-72.
32. Fasano S, Pierro L, Pantano I, Iudici M, Valentini G. Longterm hydroxychloroquine therapy and lowdose aspirin may have an additive effectiveness in the primary prevention of cardiovascular events in patients with systemic lupus erythematosus. J Rheumatol. 2017;44:1032-8.
33. Cronstein BN. Pharmacogenetics in the rheumatic diseases. Ann Rheum Dis. 2004;63:ii25-ii27.
34. Tavadia SM, Mydlarski PR, Reis MD, Mittmann N, Pinkerton PH, Shear N, et al. Screening for azathioprine toxicity: a pharmacoeconomic analysis based on a target case. J Am Acad Dermatol. 2000;42:628-32.
35. Busti AJ, Hooper JS, Amaya CJ, Kazi S. Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing. Pharmacotherapy. 2005;25:1566-91.
36. Colombel JF, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, et al. Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol. 2004;99:878-83.
37. Palmisano AC, Kuhn AW, Urquhart AG, Pour AE. Post-operative medical and surgical complications after primary total joint arthroplasty in solid organ transplant recipients: a case series. Int Orthop. 2017;41:13-9.
38. Klement MR, Penrose CT, Bala A, Wellman SS, Bolognesi MP, Seyler TM. How do previous solid organ transplant recipients fare after primary total knee arthroplasty? J Arthroplasty. 2016;31:609-615.e1.
39. Hardinger K, Magee CC. Pharmacology of cyclosporine and tacrolimus. UpToDate. Waltham, MA:UpToDate Inc.;2019 [consultado 2019 Abr 10]. Disponível em: http://www.uptodate.com/.
40. Friemann S, Feuring E, Padberg W, Ernst W. Improvement of nephrotoxicity, hypertension and lipid metabolism after conversion of kidney transplant recipients from cyclosporine to tacrolimus. Transplant Proc. 1998;30:1240-2.
41. Friemann S, Stopp K, Christ B, Weimer R, Padberg W, Ernst W. Conversion to tacrolimus in hyperlipidemic patients. Transplant Proc. 1999;31:41S-43S.
42. Thorp M, DeMattos A, Bennett W, Barry J, Norman D. The effect of conversion from cyclosporine to tacrolimus on gingival hyperplasia, hirsutism, cholesterol. Transplantation. 2000;69:1218-20.
43. Garcia SG, Lopes LS, Schott KL, Beck ST, Pomblum VJ. Ciclosporina A e tacrolimus: uma revisão. J Bras Patol Med Lab. 2004;40:393-401.
44. Mele TS, Halloran PF. The use of mycophenolate mofetil in transplant recipients. Immunopharmacology. 2000;47:215-45.
45. Sousa SR, Galante NZ, Barbosa DA, Pestana JO. Incidence of infectious complications and their risk factors in the fist year after renal transplantation. J Bras Nefrol. 2010;32:75-82.
46. Humar A, Ramcharan T, Denny R, Gillingham KJ, Payne WD, Matas AJ. Are wound complications after a kidney transplant more common with modern immunosuppression? Transplantation. 2001;72:1920-3.
47. Kremer JM, Bloom BJ, Breedveld FC, Coombs JH, Fletcher MP, Gruben D, et al. The safety and efficacy of a JAK inhibitor in patients with active rheumatoid arthritis: results of a double-blind, placebocontrolled phase IIa trial of three dosage levels of CP-690,550 versus placebo. Arthritis Rheum. 2009;60:1895-905.
48. European Medicines Agency. Um resumo sobre Xeljanz® (tofacitinib) e porque está autorizado na União Europeia. United Kingdom: European Medicines Agency, Science Medicines Health; 2018 Jun. EMA/353299/2018.
49. Food and Drug Administration. Highlights of prescribing information XELJANZ ® (tofacitinib). United States: Food and Drug Administration; 2016 Feb. Reference ID: 3891137.
50. Wollenhaupt J, Silverfield J, Lee EB, Curtis JR, Wood SP, Soma K, et al. Safety and effiacy of tofacitinib, an oral janus kinase inhibitor, for the treatment of rheumatoid arthritis in open-label, longterm extension studies. J Rheumatol. 2014;41:837-52.
51. Woodrick RS, Ruderman EM. Safety of biologic therapy in rheumatoid arthritis. Nat Rev Rheumatol. 2011;7:639-52.
52. Rubbert-Roth A. Assessing the safety of biologic agents in patients with rheumatoid arthritis. Rheumatology (Oxford). 2012;51:v38-47.
53. Goh L, Jewell T, Laversuch C, Samanta A. Should anti-TNF therapy be discontinued in rheumatoid arthritis patients undergoing elective orthopaedic surgery? A systematic review of the evidence. Rheumatol Int. 2012;32:5-13.
54. Härle P, Straub RH, Fleck M. Perioperative management of immunosuppression in rheumatic diseases-what to do? Rheumatol Int. 2010;30:999-1004.
55. Goodman SM, Paget S. Perioperative drug safety in patients with rheumatoid arthritis. Rheum Dis Clin North Am. 2012;38:747-59.
56. Jung YO, Kim HA. Recent Paradigm Shifts in the Diagnosis and Treatment of Rheumatoid Arthritis. Korean J Intern Med. 2012;27:378-87.
57. Williams RO, Feldmann M, Maini RN. Anti-tumor necrosis factor ameliorates joint disease in murine collagen-induced arthritis. Proc Natl Acad Sci U S A. 1992;89:9784-8.
58. Hirano Y, Kojima T, Kanayama Y, Shioura T, Hayashi M, Kida D, et al. Influences of antitumour necrosis factor agents on postoperative recovery in patients with rheumatoid arthritis. Clin Rheumatol. 2010;29:495-500.
59. Johnson BK, Goodman SM, Alexiades MM, Figgie MP, Demmer RT, Mandl LA. Patterns and associated risk of perioperative use of anti tumor necrosis factor in patients with rheumatoid arthritis undergoing total knee replacement. J Rheumatol 2013;40:617-23.
60. 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.
61. Maini RN, Feldmann M. How does infliximab work in rheumatoid arthritis? Arthritis Res. 2002;4:S22-8.
62. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58:826-50.
63. Haraoui B, Bykerk V. Etanercept in the treatment of rheumatoid arthritis. Ther Clin Risk Manag. 2007;3:99-105.
64. Korkina L, Trakhtman P, De Luca C, Leoni L, Raskovic D, Pastore S. Efficacy and safety of biologicals against immune-mediated diseases: do benefits outweigh risks? Drugs Today (Barc). 2010;46:119-36.
65. Mössner R, Schön MP, Reich K. Tumor necrosis factor antagonists in the therapy of psoriasis. Clin Dermatol. 2008;26:486-502.
66. European Medicines Agency. European public assessment report for Enbrel® (etanercept) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2014 Jul. EMA/398383/2014.
67. Furst DE, Ulrich RW, Prakash S. Nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, nonopioid analgesics & drugs used in gout. In: Katzung BG, Trevor AJ, Masters SB, editors. Basic and clinical pharmacology. 12th ed. United States of America: McGraw-Hill Education-Europe Publisher; 2012. p 635-57.
68. Kukar M, Petryna O, Efthimiou P. Biological targets in the treatment of rheumatoid arthritis: a comprehensive review of current and in-development biological disease modifying anti-rheumatic drugs. Biologics. 2009;3:443-57.
69. European Medicines Agency. European public assessment report for Humira® (adalimumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2017 Sep. EMA/518634/2017.
70. Deeks ED. Certolizumab pegol: a review of its use in the management of rheumatoid arthritis. Drugs. 2013;73:75-97.
71. Goel N, Stephens S. Certolizumab pegol. MAbs. 2010;2:137-47.
72. European Medicines Agency. European public assessment report for Cimzia® (certolizumab pegol) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2018 Sep. EMA/326020/2018.
73. European Medicines Agency. European public assessment report for Simponi® (golimumab) product information. United Kingdom: European Medicines Agency, Science Medicines Health; 2019 Mar. EMEA/H/C/000992-X/0083/G.
74. European Medicines Agency. European public assessment report for Simponi® (golimumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2019 Feb. EMA/552/2019.
75. Law V, Knox C, Djoumbou Y, Jewison T, Guo AC, Liu Y, et al. DrugBank 4.0: shedding new light on drug metabolism. Nucleic Acids Res. 2014;42:D1091-7.
76. European Medicines Agency. European public assessment report for Kineret® (anakinra) medicine overview. United Kingdom: European Medicines Agency, Science Medicines Health; 2018 Apr. EMA/155197/2018.
77. Howe CR, Gardner GC, Kadel NJ. Perioperative medication management for the patient with rheumatoid arthritis. J Am Acad Orthop Surg. 2006;14:544-51.
78. Mushtaq S, Goodman SM, Scanzello CR. Perioperative management of biologic agents used in treatment of rheumatoid arthritis. Am J Ther. 2011;18:426-34.
79. Hennigan S, Kavanaugh A. Interleukin-6 inhibitors in the treatment of rheumatoid arthritis. Ther Clin Risk Manag. 2008;4:767-75.
80. European Medicines Agency. European public assessment report for RoActemra® (tocilizumab) medicine overview. United Kingdom: European Medicines Agency, Science Medicines Health; 2018 Jul. EMA/490275/2018.
81. Momohara S, Hashimoto J, Tsuboi H, Miyahara H, Nakagawa N, Kaneko A, et al. Analysis of perioperative clinical features and complications after orthopaedic surgery in rheumatoid arthritis patients treated with tocilizumab in a real-world setting: results from the multicentre Tocilizumab in Perioperative Period (TOPP) study. Mod Rheumatol. 2013;23:440-9.
82. Hirao M, Hashimoto J, Tsuboi H, Nampei A, Nakahara H, Yoshio N, et al. Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab. Ann Rheum Dis. 2009;68:654-7.
83. Shah K, Lee WW, Lee SH, Kim SH, Kang SW, Craft J, et al. Dysregulated balance of Th17 and Th1 cells in systemic lupus erythematosus. Arthritis Res Ther. 2010;12:R53.
84. Menter A. The status of biologic therapies in the treatment of moderate to severe psoriasis. Cutis. 2009;84:14-24.
85. Rozenblit M, Lebwohl M. New biologics for psoriasis and psoriatic arthritis. Dermatol Ther. 2009;22:56-60.
86. European Medicines Agency. European public assessment report for Stelara® (ustekinumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2016 Oct. EMA/636854/2016.
87. Shim HH, Ma C, Kotze PG, Seow CH, Al-Farhan H, Al-Darmaki AK, et al. Preoperative ustekinumab treatment is not associated with increased postoperative complications in Crohn’s disease: a Canadian multi-centre observational cohort study. J Can Assoc Gastroenterol. 2018;1:115-23.
88. Lightner AL, McKenna NP, Tse CS, Hyman N, Smith R, Ovsepyan G, et al. Postoperative outcomes in ustekinumab-treated patients undergoing abdominal operations for Crohn’s disease. J Crohns Colitis. 2018;12:402-7.
89. Marinoni B, Ceribelli A, Massarotti MS, Selmi C. Th17 axis in psoriatic disease: pathogenetic and therapeutic implications. Auto Immun Highlights. 2014;5:9-19.
90. European Medicines Agency. European public assessment report for Cosentyx® (secukinumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2015 Nov. EMA/780949/2015.
91. European Medicines Agency. European public assessment report for Orencia® (abatacept) product information. United Kingdom: European Medicines Agency, Science Medicines Health; 2019 Mar. EMEA/H/C/000701-IG/1059.
92. Nishida K, Nasu Y, Hashizume K, Nakahara R, Ozawa M, Harada R, et al. Abatacept management during the perioperative period in patients with rheumatoid arthritis: report on eight orthopaedic procedures. Mod Rheumatol. 2014;24:544-5.
93. Latourte A, Gottenberg JE, Luxembourger C, Pane I, Claudepierre P, Richette P, et al. Safety of surgery in patients with rheumatoid arthritis treated by abatacept: data from the French Orencia in Rheumatoid Arthritis Registry. Rheumatology (Oxford). 2017;56:629-37.
94. Cohen SB, Emery P, Greenwald MW, Dougados M, Furie RA, Genovese MC, et al. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthritis Rheum. 2006;54:2793-806.
95. Mok CC. Rituximab for the treatment of rheumatoid arthritis: an update. Drug Des Devel Ther. 2014;8:87-100.
96. European Medicines Agency. European public assessment report for MabThera® (rituximab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2016 Jun. EMA/424820/2016.
97. Godot S, Gottenberg JE, Paternotte S, Pane I, Combe B, Sibilia J, et al. Safety of surgery after rituximab therapy in 133 patients with rheumatoid arthritis: data from the autoimmunity and rituximab registry. Arthritis Care Res (Hoboken). 2013;65:1874-9.
98. Cancro MP, D'Cruz DP, Khamashta MA. The role of B lymphocyte stimulator (BLyS) in systemic lupus erythematosus. J Clin Invest. 2009;119:1066-73.
99. European Medicines Agency. European public assessment report for Benlysta® (belimumab) summary for the public. United Kingdom: European Medicines Agency, Science Medicines Health; 2017 Nov. EMA/676149/2017.
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2019-12-28
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Rocha, A. C. dos S. S., & Abreu, P. (2019). Patient with Rheumatic Disease Undergoing Surgery: Handling of Antirheumatic Agents in the Perioperative Period. Journal of the Portuguese Society of Anesthesiology, 28(4), 223–231. https://doi.org/10.25751/rspa.17927
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