Background Biological DMARDs (bDMARDs) have changed prognosis of rheumatoid arthritis (RA) dramatically and it is possible to reduce RA synovitis and to inhibit progression of joint destruction using bDMARDs. However, surgical treatment such as arthroplasty is still the important procedure in especially long-standing established RA patients. Information about safety and specific adverse events in surgical treatment under bDMARD treatment is lacking.
Objectives This retrospective study investigated difference of complications between surgical treatment under bDMARDs treatment and that under conventional synthetic DMARDs (csDMARDs) treatment in RA patients.
Methods 122 surgical operations for RA patients except operation to treat infectious conditions in our institute from 2010 to 2015 were included. 45 operations were performed under bDMARDs treatment (BG) and 77 operations were performed under csDMARDs treatment (nonBG). Patients' characteristics, usage of dDMARDs, surgical site infection (SSI) and delayed wound healing (DWH) were compared between two groups. Time courses of hemoglobin (Hb), total protein, DAS28-CRP, SDAI and mHAQ after surgical operations were also compared between two groups.
Results Mean age in BG was significantly younger than that in nonBG (60.1 years old vs. 66.9 years old). MTX usage in BG was significantry higher than that in nonBG (82.2% vs. 64.9%). 48 total knee arthroplasties, 14 total hip arthroplasties, 17 operation in hand and wrist, 29 operations in foot and ankle and 14 others were included. Used bDMARDs were etanercept in 24 cases, infliximab in 7 cases, abatacept in 6 case, adalimumab in 4 cases, tocilizumab in 3 cases and golimumab in 2 cases. Mean duration between stopping bDMARDs and surgical operation was 20.5 days. There was no significant difference in occurrences of SSI cases between two groups (BG: 0.0%, nonBG: 1.3%). There was no significant difference in occurrences of DWH between two groups (BG: 4.4%, nonBG: 11.7%). SDAI and mHAQ at 1–2 months after operation in nonBG were better than that in BG. mHAQ and recovery of Hb in nonBG were also better than that in BG. A SSI occurred in operation of ankle (1/29, 3.4%). DWH were frequently observed in foot and ankle operations (6 cases, 20.7%) and hand and wrist operations (3 cases, 17.6%) (Fig1).
Conclusions There were no significant differences in SSI and DWH between BG and nonBG. mHAQ and Hb recovery after surgical operations in BG were slightly inferior to that in nonBG. This may be due to RA flare after operation in BG or differences of characteristics of patients. It was suggested that surgical region influences the occurrences of SSI and DWH and more complications were observed in foot and ankle operations.
Disclosure of Interest None declared