生物学的製剤投与中の関節リウマチ患者における手術症例の検討

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  • Peri- and Postoperative Status of Rheumatoid Arthritis Patients Receiving Biologic Disease-modifying Antirheumatic Drugs
  • セイブツガクテキ セイザイ トウヨ チュウ ノ カンセツ リウマチ カンジャ ニ オケル シュジュツ ショウレイ ノ ケントウ

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Purpose: We set out to evaluate the peri- and postoperative status of rheumatoid arthritis patients treated by biologic disease-modifying antirheumatic drugs (DMARDs).<br>Methods: Twenty-five surgical procedures in 19 rheumatoid arthritis patients were analyzed. The patients had a mean age of 55.3 (39-76) years, a disease duration of 163 (26-480) months, and a follow-up period after surgery of 21 (5-48) months. Infliximab (IFX) was administrated in 8 cases and etanercept (ETN) in 17 cases.<br>Results: Artificial arthroplasty was performed in 15 cases (knee 9, shoulder 2, elbow 2, and finger 2) synovectomy in 2, wrist joint arthroplasty in 2, forefoot surgery in 2, and others in 4. Pre- and postoperative interruption of biologics was 4 weeks in IFX cases and 2 weeks in ETN cases. Adverse events were found in 2 cases (8%, ETN 1, IFX 1): surgical site infection of superficial incisional site at 37 days after total knee arthroplasty followed by debridement, and deep infection of total knee arthroplasty at 22 months after total knee arthroplasty followed by open synovectomy and local perfusion. ETN was administrated again after 2 weeks and IFX after 13 months, respectively, because of severe joint arthritis.<br>Conclusion: For patients receiving biologic DMARDs, careful peri- and postoperative management for infection of the incisional surgical site is necessary during continuous postsurgical follow-up as well as when undergoing orthopedic surgery.

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