Background The 10-year cumulative incidence of intermediate surgeries in RA patients is about 20%. Most of RA patients, undergoing surgical treatments, are receiving immune-modulating therapy.
Objectives The German Society for Orthopedics in Rheumatic-Diseases (DGORh) has conducted a pilot study, using data from its national registry, to gain evidence on the effect of immune-modulating medications on the rate of peri- and postoperative complications.
Methods 12 centers specialized on orthopedic surgery in patients with rheumatoid diseases were included in the pilot-study. In 1000 patients undergoing surgery for inflammatory arthritis the type of rheumatic disease, the onset, types of medication, details about medication regimens and surgical treatments were documented. If a complication occurred, a consent form was used, that included information about risk-factors, date and type of observed complication as well as indicated treatments. The majority of the patients included in this pilot study (871) suffered from RAor from psoriatic arthritis in 75 cases. The median period of time from onset to the procedure leading to their inclusion in the study was 16 years (range 1 – 64years).
Results 84% of patients were treated with immune-modulating therapy (DMARS or biologicals) and 6% with corticosteroid-monotherapy. 45% of patients received Mtx, as monotherapy (19%,) or in combination with corticosteroids (11%) or adalimumab (11%). Other common drugs were leflunomide in 18% (7% monotherapy), and ertanecept in 12% (5% monotherapy). 51% of all patients received monotherapy, 32% resp. 7% were treated with two different reps. >3 types of immune-modulating medication. Wound-disorders and infections occurred in 21 of the 902 patients receiving pharmacological immune-modulating therapy and 5 of the 98 patients without specific medication. Complications were low in patients taking Mtx (2 of 233) or Eternacept (1 of 47) regardless wether intake was interrupted or not perioperatively and more frequent in patients receiving monotherapy with Leflunomid (7 of 79) or Adalimumab (2 of 28). Deep infections, requiring revision surgery, occurred in 9 patients; eight of which were patients treated with immune-modulating drugs.
Conclusions These initial results in this pilot study show, that wound complications occurred more often in patients not receiving immune-modulating medication. There is a tendency to lesser complications in patients receiving monotherapy with Metrotrexate or Eternacept in comparison to Leflunomid or Adalimumab. With respect to the limited number of complications, the different types of rheumatoid deseases, surgeries and pharmacotherapy, analytic statistics cannot yet be performed on this initial set of data. Therefore a large, comprehensive national registry that includes the most important and relevant variables that impact outcomes of these patients has been started in 2014.
Disclosure of Interest None declared