Risk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing Arthroplasty
Authors: Maarten Boers
Journal: Annals of Internal Medicine (2019)

Letters5 November 2019Risk of Biologics and Glucocorticoids in Patients With Rheumatoid Arthritis Undergoing ArthroplastyMaarten Boers, MD, PhD, MScMaarten Boers, MD, PhD, MScAmsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands (M.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0527 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:George and colleagues' (1) study on infection risk after arthroplasty in patients with rheumatoid arthritis was carefully conducted using a complex observational data set. However, their conclusions and recommendations on perioperative glucocorticoid use are ill advised. The authors found a consistent dose-dependent relationship between glucocorticoid exposure and infection risk after using propensity score modeling to limit bias. Confident with their model, they declared that this relationship “suggests that minimizing glucocorticoid use before surgery is a critical part of perioperative management.” This advice may be extremely harmful for patients.The authors' inference that glucocorticoid exposure caused infection in ...References1. George MD, Baker JF, Winthrop K, et al. Risk of biologics and glucocorticoids in patients with rheumatoid arthritis undergoing arthroplasty: a cohort study. Ann Intern Med. 2019;170:825-36. [PMID: 31108503]. doi:10.7326/M18-2217 LinkGoogle Scholar2. Lanas A, Boers M, Nuevo J. Gastrointestinal events in at-risk patients starting non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatic diseases: the EVIDENCE study of European routine practice. Ann Rheum Dis. 2015;74:675-81. [PMID: 24351518] doi:10.1136/annrheumdis-2013-204155 CrossrefMedlineGoogle Scholar3. Palmowski Y, Buttgereit T, Dejaco C, et al. “Official view” on glucocorticoids in rheumatoid arthritis: a systematic review of international guidelines and consensus statements. Arthritis Care Res (Hoboken). 2017;69:1134-41. [PMID: 28029750] doi:10.1002/acr.23185 CrossrefMedlineGoogle Scholar4. Boers M. Observational studies on glucocorticoids are harmful! [Editorial]. Lupus Sci Med. 2017;4:e000219. [PMID: 28409017] doi:10.1136/lupus-2017-000219 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands (M.B.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0527. 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 Michael D. George , Joshua F. Baker , Kevin Winthrop , and Jeffrey R. Curtis Metrics 5 November 2019Volume 171, Issue 9Page: 679-680KeywordsArthroplastyBiologicsGlucocorticoid therapyObservational studiesPeptic ulcersRheumatoid arthritisSafetySurgerySurgical outcomesSystemic diseases ePublished: 5 November 2019 Issue Published: 5 November 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...