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Disease modifying treatment and elective surgery in rheumatoid arthritis: the need for more data
  1. A Jain1,2,
  2. R Maini1,
  3. J Nanchahal3
  1. 1Kennedy Institute of Rheumatology, Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
  2. 2Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
  3. 3Department of Hand and Peripheral Nerve Surgery, University of Sydney, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
  1. Correspondence to:
    MrA Jain
    AJainUKaol.com

https://doi.org/10.1136/ard.2003.017640

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    Disease modifying antirheumatic drugs (DMARDs) have become the cornerstone of treatment for patients with rheumatoid arthritis. The use of these drugs during the perioperative period has caused debate amongst rheumatologists and surgeons. Concerns focus on their potential to increase the risk of infection by affecting the immune response. Rheumatoid patients are at increased risk of infection,1 and this is of concern after surgery.2 Orthopaedic surgery in rheumatoid patients is common,3 and while it may seem prudent to stop DMARD treatment before surgery, this may result in flare up of disease activity. The resultant loss of mobility would adversely affect outcome, particularly after orthopaedic procedures, where mobilisation is crucial for effective rehabilitation.2,4

    Early reports suggested that methotrexate should be stopped before rheumatoid surgery, as it was claimed to increase infection rates. Studies have …

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    Footnotes

    • CONFLICT OF INTEREST STATEMENT
      The Kennedy Institute received a research grant and payment (according to the number of patients) for clinical trials of an anti-TNF antibody from Centocor Inc, Malvern, Pennsylvania, USA. Professor Maini has acted as a consultant.