Background Biologic agents have brought about a paradigm shift in the therapy for rheumatoid arthritis (RA). Whether risk of postoperative infection is increased by biologics agents remains controversial1,2.
Objectives To clarify whether biologic agents increase the risk of postoperative infection in a retrospective investigation of RA patients following orthopedic surgery.
Methods This study was a retrospective three-center review of orthopedic operations for RA patients conducted between April 2006 and May 2012. Patients who had been followed for over 1 year were enrolled. We used multivariate logistic regression analysis to analyze risk factors influencing risk of acute surgical-site infection (SSI) at both superficial and deep sites, delayed wound healing and chronic infection.
Results A total of 408 operations for 227 RA patients (204 females, 23 males) were performed. Mean age was 64.9 years and mean disease duration was 16.8 years. Usage rates of biologic agents and disease-modifying antirheumatic drugs (DMARDs) were 31.6% and 92.2%, respectively. Details of patient background are shown in Table 1. Biologic agents used included infliximab (59 cases), etanercept (53 cases), tocilizumab (8 cases), adalimumab (6 cases) and abatacept (3 cases). Risk factors for superficial SSI included age and operation time (odds ratios (ORs): 1.15 and 1.01, respectively). Risk factors for deep SSI were operation time and disease activity (ORs: 1.05 and 7.26, respectively). Risk factors for delayed wound healing were age, operation time and foot operation (ORs: 1.15, 1.01, and 2.88, respectively). Biologic agents did not represent a risk factor for any outcome examined (superficial SSI, p=0.9; deep SSI, p=0.67; delayed wound healing, p=0.12; chronic infection, p=0.9). There were no differences between biologics agents about the influence on postoperative infection.
Conclusions Biologic agents do not represent a risk factor for postoperative infection in RA patients. Foot operation was a risk factor for delayed wound healing and warrants care in terms of peri- and postoperative management.
Momohara S, Kawakami K, Iwamoto T, et al. Prosthetic joint infection after total hip or knee arthroplasty in rheumatoid arthritis patients treated with nonbiologic and biologic disease-modifying antirheumatic drugs. Mod Rheumatol. 2011; 21:469-75.
den Broeder AA, Creemers MC, Fransen J, et al. Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study. J Rheumatol. 2007; 34:689-95.
Garnero P, Delmas PD. Noninvasive techniques for assessing skeletal changes in inflammatory arthritis: bone biomarkers. Curr Opin Rheumatol. 2004; 16:428-34.
Disclosure of Interest M. Tada: None declared, T. Koike Grant/research support: Takeda Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Chugai Pharmaceutical, Eisai, Abbott Japan, Teijin Pharma, Banyu Pharmaceutical and Ono Pharmaceutical, K. Inui Grant/research support: Chugai Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Speakers bureau: Bristol-Myers K.K., Takeda Pharmaceutical Corporation, Ltd., Y. Sugioka: None declared, K. Mamoto: None declared, T. Okano: None declared, H. Nakamura Grant/research support: Chugai Pharmaceutical Co., Ltd., Astellas Pharma Inc., Nippon Zoki Pharmaceutical Co., Ltd., Daiichi Sankyo, Speakers bureau: Eisai Co.,Ltd., Daiichi Sankyo
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