Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-α blockers: Perioperative interruption of tumour necrosis factor-a blockers decreases complications?

Kosei Kawakami, Katsunori Ikari, Koichiro Kawamura, So Tsukahara, Takuji Iwamoto, Koichiro Yano, Yu Sakuma, Asami Tokita, Shigeki Momohara

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Objective. TNF-α blockers reportedly increase the risk of complications in rheumatic patients following surgery. Whereas deep venous thrombosis (DVT) is a significant complication after orthopaedic surgery of the lower limbs, the risk for DVT in RA patients receiving TNF blockers remains unclear. The aim of this study was to identify complications that can be attributed to the use of TNF-α blocker therapy. Methods. In a retrospective 1:1 pair-matched case-control study, 64 anti-TNF-treated RA surgeries (TNF group) and 64 surgeries treated with conventional DMARDs (DMARDS group) were evaluated for surgical site infection (SSI), DVT and recurrence of arthritis (flare-up). Multivariate logistic regression analysis was performed to test the association of SSI or DVT with the putative risk factors. Results. Regression analysis identified the use of TNF blockers as a risk factor for SSI [P = 0.036; odds ratio (OR) = 21.80] and development of DVT (P = 0.03; OR = 2.83) after major orthopaedic surgery: 12.5% (8/64) of the patients in the TNF group had SSI, whereas 2% (1/64) of those in the DMARDs group had SSI. Fifty-one per cent (23/45) of the TNF group, but only 26% (12/45) of the DMARDs group was DVT positive. Flare-ups during the perioperative period were found in 17.2% (11/64) of all patients, and no delay in wound healing occurred in either group. Conclusions. These data suggest that the use of TNF blockers is a likely cause of SSI and DVT development in RA patients following major orthopaedic surgery.

Original languageEnglish
Article numberkep376
Pages (from-to)341-347
Number of pages7
JournalRheumatology
Volume49
Issue number2
DOIs
Publication statusPublished - 2010 Feb
Externally publishedYes

Fingerprint

Surgical Wound Infection
Venous Thrombosis
Rheumatoid Arthritis
Tumor Necrosis Factor-alpha
Joints
Antirheumatic Agents
Orthopedics
Odds Ratio
Regression Analysis
Perioperative Period
Wound Healing
Arthritis
Case-Control Studies
Lower Extremity
Logistic Models
Recurrence

Keywords

  • Deep venous thrombosis
  • Joint surgery
  • Rheumatoid arthritis
  • Surgical site infection
  • Tumor necrosis factor-α blockers

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

Cite this

Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-α blockers : Perioperative interruption of tumour necrosis factor-a blockers decreases complications? / Kawakami, Kosei; Ikari, Katsunori; Kawamura, Koichiro; Tsukahara, So; Iwamoto, Takuji; Yano, Koichiro; Sakuma, Yu; Tokita, Asami; Momohara, Shigeki.

In: Rheumatology, Vol. 49, No. 2, kep376, 02.2010, p. 341-347.

Research output: Contribution to journalArticle

Kawakami, Kosei ; Ikari, Katsunori ; Kawamura, Koichiro ; Tsukahara, So ; Iwamoto, Takuji ; Yano, Koichiro ; Sakuma, Yu ; Tokita, Asami ; Momohara, Shigeki. / Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-α blockers : Perioperative interruption of tumour necrosis factor-a blockers decreases complications?. In: Rheumatology. 2010 ; Vol. 49, No. 2. pp. 341-347.
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title = "Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-α blockers: Perioperative interruption of tumour necrosis factor-a blockers decreases complications?",
abstract = "Objective. TNF-α blockers reportedly increase the risk of complications in rheumatic patients following surgery. Whereas deep venous thrombosis (DVT) is a significant complication after orthopaedic surgery of the lower limbs, the risk for DVT in RA patients receiving TNF blockers remains unclear. The aim of this study was to identify complications that can be attributed to the use of TNF-α blocker therapy. Methods. In a retrospective 1:1 pair-matched case-control study, 64 anti-TNF-treated RA surgeries (TNF group) and 64 surgeries treated with conventional DMARDs (DMARDS group) were evaluated for surgical site infection (SSI), DVT and recurrence of arthritis (flare-up). Multivariate logistic regression analysis was performed to test the association of SSI or DVT with the putative risk factors. Results. Regression analysis identified the use of TNF blockers as a risk factor for SSI [P = 0.036; odds ratio (OR) = 21.80] and development of DVT (P = 0.03; OR = 2.83) after major orthopaedic surgery: 12.5{\%} (8/64) of the patients in the TNF group had SSI, whereas 2{\%} (1/64) of those in the DMARDs group had SSI. Fifty-one per cent (23/45) of the TNF group, but only 26{\%} (12/45) of the DMARDs group was DVT positive. Flare-ups during the perioperative period were found in 17.2{\%} (11/64) of all patients, and no delay in wound healing occurred in either group. Conclusions. These data suggest that the use of TNF blockers is a likely cause of SSI and DVT development in RA patients following major orthopaedic surgery.",
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T1 - Complications and features after joint surgery in rheumatoid arthritis patients treated with tumour necrosis factor-α blockers

T2 - Perioperative interruption of tumour necrosis factor-a blockers decreases complications?

AU - Kawakami, Kosei

AU - Ikari, Katsunori

AU - Kawamura, Koichiro

AU - Tsukahara, So

AU - Iwamoto, Takuji

AU - Yano, Koichiro

AU - Sakuma, Yu

AU - Tokita, Asami

AU - Momohara, Shigeki

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N2 - Objective. TNF-α blockers reportedly increase the risk of complications in rheumatic patients following surgery. Whereas deep venous thrombosis (DVT) is a significant complication after orthopaedic surgery of the lower limbs, the risk for DVT in RA patients receiving TNF blockers remains unclear. The aim of this study was to identify complications that can be attributed to the use of TNF-α blocker therapy. Methods. In a retrospective 1:1 pair-matched case-control study, 64 anti-TNF-treated RA surgeries (TNF group) and 64 surgeries treated with conventional DMARDs (DMARDS group) were evaluated for surgical site infection (SSI), DVT and recurrence of arthritis (flare-up). Multivariate logistic regression analysis was performed to test the association of SSI or DVT with the putative risk factors. Results. Regression analysis identified the use of TNF blockers as a risk factor for SSI [P = 0.036; odds ratio (OR) = 21.80] and development of DVT (P = 0.03; OR = 2.83) after major orthopaedic surgery: 12.5% (8/64) of the patients in the TNF group had SSI, whereas 2% (1/64) of those in the DMARDs group had SSI. Fifty-one per cent (23/45) of the TNF group, but only 26% (12/45) of the DMARDs group was DVT positive. Flare-ups during the perioperative period were found in 17.2% (11/64) of all patients, and no delay in wound healing occurred in either group. Conclusions. These data suggest that the use of TNF blockers is a likely cause of SSI and DVT development in RA patients following major orthopaedic surgery.

AB - Objective. TNF-α blockers reportedly increase the risk of complications in rheumatic patients following surgery. Whereas deep venous thrombosis (DVT) is a significant complication after orthopaedic surgery of the lower limbs, the risk for DVT in RA patients receiving TNF blockers remains unclear. The aim of this study was to identify complications that can be attributed to the use of TNF-α blocker therapy. Methods. In a retrospective 1:1 pair-matched case-control study, 64 anti-TNF-treated RA surgeries (TNF group) and 64 surgeries treated with conventional DMARDs (DMARDS group) were evaluated for surgical site infection (SSI), DVT and recurrence of arthritis (flare-up). Multivariate logistic regression analysis was performed to test the association of SSI or DVT with the putative risk factors. Results. Regression analysis identified the use of TNF blockers as a risk factor for SSI [P = 0.036; odds ratio (OR) = 21.80] and development of DVT (P = 0.03; OR = 2.83) after major orthopaedic surgery: 12.5% (8/64) of the patients in the TNF group had SSI, whereas 2% (1/64) of those in the DMARDs group had SSI. Fifty-one per cent (23/45) of the TNF group, but only 26% (12/45) of the DMARDs group was DVT positive. Flare-ups during the perioperative period were found in 17.2% (11/64) of all patients, and no delay in wound healing occurred in either group. Conclusions. These data suggest that the use of TNF blockers is a likely cause of SSI and DVT development in RA patients following major orthopaedic surgery.

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KW - Rheumatoid arthritis

KW - Surgical site infection

KW - Tumor necrosis factor-α blockers

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