Building the Evidence Base
The updated guideline does not provide information with respect to patients on multiple therapies. Dr. Singh explains that little to no evidence currently exists about how to handle DMARD combination therapy in the perioperative period. We also don’t have much information about the benefits of holding one vs. two doses of these drugs.
One research challenge, Dr. Singh points out, is that the baseline risk of these infections is low, so it can take very large study sizes to see differences in rates of infection or other complications. He would also like to see prospective studies of rates of flares in these patients, in addition to the current retrospective data. “We have unanswered questions in almost every sphere of the guideline; we would ideally want high quality randomized trials in several of these conditions for almost every medication,” he adds.
Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.
References
- Goodman SM, Springer BD, Chen AF, et al. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Care Res (Hoboken). 2022 Jun 19;10.1002/acr.24893.
- Goodman SM, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Care Res (Hoboken). 2017 Aug;69(8):1111–1124.
- Ravi B, Croxford R, Hollands S, et al. Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis. Arthritis Rheumatol. 2014 Feb;66(2):254–263.
