Elucidating the Risks and Benefits of Withholding Biologics to Optimize Surgical Outcomes
Authors: Bheeshma Ravi, Gillian Hawker
Journal: Annals of Internal Medicine (2019)

Editorials18 June 2019Elucidating the Risks and Benefits of Withholding Biologics to Optimize Surgical OutcomesCorrection(s) for this article:CorrectionsOct 2019Correction: Withholding Biologics to Optimize Surgical OutcomesFREEBheeshma Ravi, MD, PhD and Gillian Hawker, MD, MScBheeshma Ravi, MD, PhDUniversity of Toronto, Toronto, Ontario, Canada (B.R., G.H.)Search for more papers by this author and Gillian Hawker, MD, MScUniversity of Toronto, Toronto, Ontario, Canada (B.R., G.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1088 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This article has been corrected. The original version (PDF) is appended to this article as a Supplement.The introduction of biologic therapies for the treatment of rheumatoid arthritis (RA) has resulted in a paradigm shift in the experience of RA for both patients and clinicians. These genetically engineered therapies target and disrupt specific immune system signals that cause and perpetuate the disease. Although not a cure for RA, biologic therapies can dramatically slow disease progression—but they may also increase risk for infection.George and colleagues (1) report a retrospective cohort study that used administrative claims data (Medicare and Truven MarketScan) ...References1. George MD, Baker JF, Winthrop K, Alemao E, Chen L, Connolly S, et al. Risk of biologics and glucocorticoids in patients with rheumatoid arthritis undergoing arthroplasty. A cohort study. Ann Intern Med. 2019;170:825-36. doi:10.7326/M18-2217 LinkGoogle Scholar2. Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, 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 Rheumatol. 2017;69:1538-51. [PMID: 28620948] doi:10.1002/art.40149 CrossrefMedlineGoogle Scholar3. Strand V, Ahadieh S, French J, Geier J, Krishnaswami S, Menon S, et al. Systematic review and meta-analysis of serious infections with tofacitinib and biologic disease-modifying antirheumatic drug treatment in rheumatoid arthritis clinical trials. Arthritis Res Ther. 2015;17:362. [PMID: 26669566] doi:10.1186/s13075-015-0880-2 CrossrefMedlineGoogle Scholar4. Singh JA, Cameron C, Noorbaloochi S, Cullis T, Tucker M, Christensen R, et al. Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet. 2015;386:258-65. [PMID: 25975452] doi:10.1016/S0140-6736(14)61704-9 CrossrefMedlineGoogle Scholar5. Maxwell LJ, Zochling J, Boonen A, Singh JA, Veras MM, Tanjong Ghogomu E, et al. TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database Syst Rev. 2015:CD005468. [PMID: 25887212] doi:10.1002/14651858.CD005468.pub2 CrossrefMedlineGoogle Scholar6. Cordtz RL, Zobbe K, Højgaard P, Kristensen LE, Overgaard S, Odgaard A, et al. Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers. Ann Rheum Dis. 2018;77:281-8. [PMID: 29097373] doi:10.1136/annrheumdis-2017-212339 CrossrefMedlineGoogle Scholar7. Ravi B, Croxford R, Hollands S, Paterson JM, Bogoch E, Kreder H, et al. Increased risk of complications following total joint arthroplasty in patients with rheumatoid arthritis. Arthritis Rheumatol. 2014;66:254-63. [PMID: 24504797] doi:10.1002/art.38231 CrossrefMedlineGoogle Scholar8. Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E. Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Joint Surg Am. 2004;86-A:1909-16. [PMID: 15342752] CrossrefMedlineGoogle Scholar9. Ravi B, Croxford R, Austin PC, Hollands S, Paterson JM, Bogoch E, et al. Increased surgeon experience with rheumatoid arthritis reduces the risk of complications following total joint arthroplasty. Arthritis Rheumatol. 2014;66:488-96. [PMID: 24574207] doi:10.1002/art.38205 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Toronto, Toronto, Ontario, Canada (B.R., G.H.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1088.Corresponding Author: Gillian Hawker, MD, MSc, Department of Medicine, Suite RFE 3-805, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada; e-mail, g.[email protected]ca.Current Author Addresses: Dr. Ravi: Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.Dr. Hawker: Department of Medicine, Suite RFE 3-805, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.This article was published at Annals.org on 21 May 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRisk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing Arthroplasty Michael D. George , Joshua F. Baker , Kevin Winthrop , Evo Alemao , Lang Chen , Sean Connolly , Jesse Y. Hsu , Teresa A. Simon , Qufei Wu , Fenglong Xie , Shuo Yang , and Jeffrey R. Curtis Correction: Withholding Biologics to Optimize Surgical Outcomes Metrics Cited byCorrection: Withholding Biologics to Optimize Surgical OutcomesInfections with bDMARDs and glucocorticoids before arthroplasty 18 June 2019Volume 170, Issue 12Page: 886-887KeywordsArthroplastyBiologicsCohort studiesGlucocorticoid therapyHipJoint replacement surgeryKneesMethotrexateProsthetic device infectionsSurgeons ePublished: 21 May 2019 Issue Published: 18 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...