Reference |
Study Design |
Sample Size |
Study Population/Procedures |
Duration of Follow-Up |
Key Findings |
Level of Evidence |
Bibbo and Goldberg, 200446 |
Prospective observational study |
31 patients; n = 15, received TNF-α therapy; n = 16, no TNF-α therapy |
RA patients undergoing elective foot and ankle surgery |
12 mo |
TNF-α therapy may be safely administered perioperatively without significantly increasing the risk of infection or healing complications in RA patients undergoing elective foot and ankle surgery |
II |
Hirano et al., 201047 |
Retrospective cohort study |
113 patients n = 39, anti-TNF therapy n = 74, non-TNF/traditional DMARDs |
RA patients undergoing orthopedic operations (primary total hip arthroplasty, total knee arthroplasty, total elbow arthroplasty, total ankle arthroplasty, total shoulder arthroplasty, ankle arthrodesis) |
April of 2004–July of 2007 |
Anti-TNF agents do not cause specific adverse events on surgical wounds after elective orthopedic procedures in RA patients |
III |
Talwalkar et al., 200548 |
Retrospective cohort study |
16 operations in 11 patients; n = 4, anti-TNF therapy; n = 12, discontinued anti-TNF therapy |
RA patients and a psoriatic patient undergoing wrist replacement, total ankle replacement, and total hip replacement |
— |
No evidence that anti-TNF agents, whether continued or discontinued, increased rate of infection or complications |
III |
Wendling et al., 200549 |
Retrospective cohort study |
50 procedures in 30 patients; n = 32, anti-TNF agent; n = 18, discontinued anti-TNF therapy |
RA patients undergoing orthopedic operations (foot and ankle, hand, wrist, total joint replacements) and nonorthopedic operations (head and neck, abdomen) |
14 mo |
No increased frequency of adverse events caused by uninterrupted use of anti-TNF therapy in RA patients undergoing surgery; however, increased incidence of RA flares were associated with anti-TNF interruption (5/6 flares discontinued therapy). |
III |
den Broeder et al., 200750 |
Retrospective cohort study |
1219 procedures in 768 patients; n = 1023, TNF-naive patients; n = 104, discontinued anti-TNF treatment; n = 92, continued anti-TNF treatment |
RA patients undergoing elective orthopedic surgery |
January of 2001–September of 2004 |
Continuation or interruption of established anti-TNF therapy does not seem to have major influence on risk of SSI; however, wound dehiscence and bleeding seemed to occur more frequently in patients that continued anti-TNF treatment (9.8% vs. 4.4%) |
III |
Kawakami et al., 201051 |
Retrospective 1:1 pair-matched case-control study |
128 procedures in 112 patients; n = 64, anti-TNF therapy; n = 64, conventional DMARDs |
RA patients undergoing joint surgery (total shoulder arthroplasty, elbow arthroplasty, implant replacement arthroplasty of MCP joints, wrist arthroplasty, total hip arthroplasty, total knee arthroplasty, synovectomy of knee, total ankle arthroplasty, foot surgery, ankle arthrodesis, ORIF hip hemiarthroplasty) |
May of 2004–March of 2009 |
Use of TNF-α blockers is a suspected risk factor for SSI in RA patients; 12.5% of TNF patients had SSI versus 2% of DMARDs patients |
III |
Giles et al., 200652 |
Retrospective case-control study |
91 patients; n = 35, TNF inhibitor therapy; n = 56, TNF-naive |
RA patients undergoing orthopedic surgery (large joint arthroplasty, fusion/resection, small joint procedures, revision arthroplasty) |
January of 1999–March of 2004 |
TNF inhibitor therapy significantly associated with development of a serious postoperative infection (OR, 4.4; 95% CI, 1.10–18.41); association remains statistically significant after adjustment for age, sex, disease duration, prednisone use, diabetes, and serum rheumatoid factor status |
III |
Godot et al., 201353 |
Retrospective case series |
140 procedures in 133 patients |
RA patients undergoing surgery within 1 yr following infusion of rituximab; orthopedic operations represented 68% of procedures, abdominal surgery, 16.5%; and other, 15.5% |
1 yr following rituximab infusion |
Nine patients (6.7%) experienced 12 complications (8.5%), including 8 surgical-site infections (5.7%) and 1 death caused by septic shock |
IV |
Nishida et al., 201454 |
Retrospective case series |
8 procedures in 7 patients |
Female RA patients on abatacept therapy who had discontinued treatment before orthopedic surgery (metatarsal bone osteotomy, tenosynovectomy, implant removal, wrist/finger arthroplasties, total knee arthroplasty) |
January of 2011–December of 2012 |
No postoperative infection, delayed wound healing, or flare-up of disease; average preoperative abatacept discontinuation was 15.9 days, and total discontinuation time was 33.1 days |
IV |
Momohara et al., 201355 |
Retrospective case series |
161 procedures in 122 patients |
RA patients on tocilizumab therapy undergoing orthopedic operations |
1999–2010 |
3 postoperative infections, 20 delayed wound healing, 36 RA symptom flare-ups; average preoperative discontinuation time was 23.5 days |
IV |
Hirao et al., 200956 |
Retrospective 1:1 pair-matched case-control study |
n = 22, tocilizumab therapy; n = 22, conventional DMARDs |
RA patients on tocilizumab therapy who underwent orthopedic operations (shoulder arthroplasty, total elbow arthroplasty, total hip arthroplasty, total knee arthroplasty, total ankle arthroplasty, foot surgery, hand surgery); last infusion of tocilizumab on average 16.1 days before surgery |
— |
No complications of superficial or deep infection, delayed wound healing observed in either group |
III |
Reich et al., 201157 |
Randomized, multicenter, double-blind, placebo-controlled, prospective study |
n = 1582, ustekinumab-treated; n = 732, placebo-treated |
Patients with moderate to severe psoriasis with a diagnosis of at least 6 mo |
36 mo |
No increased risk of MI or stroke in ustekinumab-treated patients |
I |
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