Background Recent studies showed that biologic agents (biologics) may increase the risk of perioperative complications. However, there were limited reports that investigated detailed perioperative clinical features in patients with rheumatoid arthritis (RA) treated with biologics.
Objectives The purposes of this study were to investigate perioperative clinical features and complications in RA patients treated with biologics. These data were compared to patients treated without biologics. Clinical features and complications were also analyzed according to surgical procedure.
Methods Between 2007 and 2011, patients who underwent orthopaedic surgeries treated with biologics were reviewed (Group A; 53 females and 4 males). We also selected patients who were treated without biologics during same time period with adjusting the age and the ratio of male and female (Group B; 55 females and 3 males). In addition, patients in Group A were divided into major surgery (28 patients; total hip, knee, elbow, and ankle arthroplasty) or with minor surgery (29 patients; other orthopaedic joint surgery). In both groups, perioperative general conditions and orthopaedic complications (surgical site infection; SSI, delayed wound healing) were investigated. As the assessments of perioperative clinical features, the levels of C-reactive protein (CRP), white blood cell (WBC), total protein (TP), albumin (Alb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine (Cr), and MMP-3 were examined. As the assessments of recovery of patient’s general status after surgery, the %recovery of TP (%TP), %recovery of Alb (%Alb), and %recovery of Hb (%Hb) were examined. The %recovery was defined as follows: (2-week postoperative level/preoperative level)×100%.
Results Perioperative laboratory data showed no statistical significant difference between two groups at any study period. There were also no statistical significant differences in %TP, %Alb, and %Hb between two groups. In Group A, mean level of CRP at 1 week after surgery (3.9mg/dl) were significantly higher in patients with major surgery than in patients with minor surgery (1.1mg/dl) (p<0.01), but there was no statistical significant difference at 2 and 4 weeks after surgery. SSI were observed in 3 patients in Group A (major surgery: 2, minor surgery: 1), but no patient had SSI in Group B. Delayed wound healings were observed in 1 patient in Group A (1.8%; minor surgery) and 4 patients in Group B (6.9%; 3 patients in major surgery and 1 in minor surgery). The rate of occurrence in delayed wound healing was observed with no statistical significant difference between two groups. In patients with SSI or delayed wound healing, perioperative laboratory data showed no statistical significant difference when compared with the data in patients without SSI or delayed wound healing.
Conclusions Most of orthopaedic surgeries in RA patients treated with biologics were performed safely when compared with the patients treated without biologics. In patients treated with biologics, perioperative complications and clinical features showed no conspicuous difference regardless of surgical procedure. The treatment with biologics also did not affect the recovery of patient’s general status after surgery.
Disclosure of Interest None Declared