Risk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing Arthroplasty
Authors: Michael D. George, Joshua F. Baker, Kevin Winthrop, Jeffrey R. Curtis
Journal: Annals of Internal Medicine (2019)

Letters5 November 2019Risk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing ArthroplastyMichael D. George, MD, MSCE, Joshua F. Baker, MD, MSCE, Kevin Winthrop, MD, MPH, and Jeffrey R. Curtis, MD, MS, MPHMichael D. George, MD, MSCEUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.G.), Joshua F. Baker, MD, MSCEUniversity of Pennsylvania Perelman School of Medicine and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (J.F.B.), Kevin Winthrop, MD, MPHOregon Health & Science University, Portland, Oregon (K.W.), and Jeffrey R. Curtis, MD, MS, MPHUniversity of Alabama at Birmingham, Birmingham, Alabama (J.R.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0528 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Boers that disease severity may affect outcomes after arthroplasty and may cause confounding. However, we believe that there are several reasons to remain concerned about the risk of higher-dose glucocorticoids before these procedures.Covariate balance was excellent for patients receiving glucocorticoid dosages of 5 mg/d or less and 5 to 10 mg/d. Although the associations we found for these lower-dosage groups were modest in magnitude, they represent a clinically meaningful absolute risk difference for hospitalized infection or readmission (1 to 2 events per 100 patients). A consistent dose-dependent risk was observed across multiple outcomes.... References1. 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[PMID: 29246162] doi:10.1186/s13075-017-1466-y CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.G.)University of Pennsylvania Perelman School of Medicine and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (J.F.B.)Oregon Health & Science University, Portland, Oregon (K.W.)University of Alabama at Birmingham, Birmingham, Alabama (J.R.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2217. 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 Risk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing Arthroplasty Maarten Boers Metrics Cited byPerioperative management of patients with inflammatory rheumatic diseasesFortsetzen oder Pausieren? Die antirheumatische Therapie bei elektiven OperationenConsensus statement on blocking interleukin-6 receptor and interleukin-6 in inflammatory conditions: an updateFortsetzen oder Pausieren? Die antirheumatische Therapie bei elektiven OperationenPreoperative Management of Medications for Rheumatologic and HIV Diseases: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus StatementRecalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapyPerioperativer Umgang mit der Therapie von Patienten mit entzündlich rheumatischen ErkrankungenTotal Hip Arthroplasty in the Treatment of Inflammatory ArthritisPerioperative Glucocorticoids in Patients With Rheumatoid Arthritis Having Total Joint Replacements: Help or Harm?Postoperative Infection Risk in Total Joint Arthroplasty After Perioperative IV Corticosteroid Administration: A Systematic Review and Meta-Analysis of Comparative Studies 5 November 2019Volume 171, Issue 9Page: 680KeywordsArthroplastyBiologicsDisclosureObservational studiesRandomized trialsRelative riskRheumatoid arthritisSafetySurgeonsSurgery ePublished: 5 November 2019 Issue Published: 5 November 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. 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