Skip to main content
Top

25-06-2018 | Rheumatoid arthritis | Review | Article

Optimizing Rheumatoid Arthritis Patients for Surgery

Journal: Current Rheumatology Reports

Authors: Alana Sigmund, Linda A. Russell

Publisher: Springer US

Abstract

Purpose of Review

The purpose of this review is to guide providers on how best to optimize the health of patients with rheumatoid arthritis (RA) planning surgery, to reduce risk and complications and achieve the best outcomes.

Recent Findings

The American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) have issued a recent guideline on perioperative management of antirheumatic medications in patients with RA.

Summary

Patients with RA will continue to need surgery. Newer literature is helping to plan the perioperative period to help reduce complications and improve outcomes.
Literature
1.
Goodman SM, Figgie MA. Arthroplasty in patients with established rheumatoid arthritis (RA): mitigating risks and optimizing outcomes. Best Pract Res Clin Rheumatol. 2015;29(4–5):628–42. https://​doi.​org/​10.​1016/​i.​berh.​2015.​09.​004.CrossRefPubMed
2.
Mertelsmann-Voss C, Lyman s PTJ, Goodman SM, Figgie MP, Mandl LA. US trends in rates of arthroplasty for inflammatory arthritis including rheumatoid arthritis, juvenile idiopathic arthritis, and spondyloarthritis. Arthritis Rheum. 2014;66(6):1432–9. https://​doi.​org/​10.​1002/​art.​38384.CrossRef
3.
Waljee J, Zhong L, Baser O, Yuce H, Fox DA, Chung KC. The incidence of upper and lower extremity surgery for rheumatoid arthritis among Medicare beneficiaries. J Bone Joint Surg Am. 2015;97(5):403–10. https://​doi.​org/​10.​2106/​JBJS.​N.​00802.CrossRefPubMedPubMedCentral
4.
Nikiphorou E, Carpenter L, Morris S, MacGregor AJ, Dixey J, Kiely P, et al. Hand and foot surgery rates in rheumatoid arthritis have declined from 1986 to 2011, but large-joint replacement rates remain unchanges: results from two UK inception cohorts. Arthritis Rheum. 2014;66(5):1081–9. https://​doi.​org/​10.​1002/​art.​38344.CrossRef
5.
Turesson C, Matteson EL. Rheumatoid arthritis and other synovial disorders “Extraarticular features of rheumatoid arthritis and systemic involvement” section 6, Chapter 86. 2015. pp. 712–719.
6.
Agca R, Heslinga SC, Rollefstad S, Heslinga M, TK MIIBPMJK, Dougados M, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76(1):17–28. https://​doi.​org/​10.​1136/​annrheumdis-2016-209775.CrossRefPubMed
7.
Yazdanyar A, Wasko MC, Kraemer W. Perioperative all-cause mortality and cardiovascular events in patients with rheumatoid arthritis: comparison with unaffected controls and persons with diabetes mellitus. Arthritis Rheum. 2012;64(8):2429–37. https://​doi.​org/​10.​1002/​art.​34428.CrossRefPubMedPubMedCentral
8.
• Tropea J, Brand CA, Bohensky M, Van Doornum S. Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis: a retrospective cohort study. Arthritis Res Ther. 2016;18:69. https://​doi.​org/​10.​1186/​s13075-016-0958-5. In this retrospective analysis of patients with rheumatoid arthritis undergoing joint surgery, rheumatoid arthritis patients were found to be at increased risk of death at 6 weeks after surgery, and MI and death 12 months after surgery. CrossRefPubMedPubMedCentral
9.
Lee TH, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–49.
10.
Munsterman T, Takken T, Wittink H. Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity. BMC Musculoskelet Disord. 2012;13:202. http://​www.​biomedcentral.​com/​1471-2474/​13/​202 CrossRefPubMedPubMedCentral
11.
Duceppe Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, Graham M, et al. Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Can J Cardiol. 2017 Jan;33(1):17–32. https://​doi.​org/​10.​1016/​j.​cjca.​2016.​09.​008.CrossRefPubMed
12.
Goodman SM, Bykerk VP, DiCarlo E, Cummings RW, Donlin LT, Orange DE, et al. Flares in patients with rheumatoid arthritis after total hip and total knee arthroplasty: rates, characteristics, and risk factors. J Rheumatol. 2018;45(5):604–22. https://​doi.​org/​10.​3899/​jrheum.​170366.CrossRefPubMed
13.
Goodman SM, Miller AS, Turgunbaev, et al. Clincal practice guidelines: incorporating input from a patient panel. Arthritis Care Res. 2017;69(8):1125–30. https://​doi.​org/​10.​1002/​acr.​23275.CrossRef
14.
Goodman SM. Optimizing perioperative outcomes for older patients with rheumatoid arthritis undergoing arthroplasty: emphasis on medication management. Drugs Aging. 2015;32(5):361–9. https://​doi.​org/​10.​1007/​s40266-015-0262-0.​ CrossRefPubMed
15.
Goodman SM, Menon I, Christos PJ, Smethurst R, Bykerk VP. Management of perioperative tumor necrosis factor α inhibitors in rheumatoid arthritis patients undergoing arthroplasty: a systematic review and meta-analysis. Rheumatology (Oxford). 2016;55(3):573–82. https://​doi.​org/​10.​1093/​rheumatology/​kev364.​ CrossRef
16.
Clay M, Mazouyes A, Gilson M, Gaudin P, Baillet A. Risk of postoperative infections and the discontinuation of TNF inhibitors in patients with rheumatoid arthritis: a meta-analysis. Joint Bone Spine. 2016;83(6):701–5. https://​doi.​org/​10.​1016/​i.​jbspin.​2015.​10.​019.CrossRefPubMed
17.
Godot S, Gottenberg JE, Paternotte S, Pane I, Combe B, Sibilia J, et al. Safety of surgery after rituximab therapy in 133 patients with rheumatoid arthritis: data from the AutoImmunity and Rituximab Registry. Arthritis Care Res (Hoboken). 2013;65(11):1874–9. https://​doi.​org/​10.​1002/​acr.​22056.CrossRef
18.
•• SM G, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Rheum. 2017;69(8):1538–51. https://​doi.​org/​10.​1002/​art.​40149. This is an evidence-based, updated guideline regarding the management of antirheumatic drug therapy for patients undergoing hip and knee arthroplasty. CrossRef
19.
Ochi K, Inoue E, Furuya, et al. Ten-year incidences of self-reported non-vertebral fractures in Japanese patients with rheumatoid arthritis: discrepancy between disease activity control and the incidence of non-vertebral fractures. Osteoporos Int. 2015;26(3):961–8. https://​doi.​org/​10.​1007/​s00198-014-2911-2.CrossRefPubMed
20.
Kang CN, Kim CVV, Moon JK. The outcomes of instrumented posterolateral lumbar fusion in patients with rheumatoid arthritis. Bone Joint J. 2016;98-B(1):102–8. https://​doi.​org/​10.​1302/​0301-620X.​98B1.​36247.CrossRefPubMed
21.
Ebina K, Hashimoto J, Shi K, Kashii M, Hirao M, Yoshikawa H. Comparison of the effect of 18-month daily teriparatide administration on patients with rheumatoid arthritis and postmenopausal osteoporosis patients. Osteoporos Int. 2014;25(12):2755–65. https://​doi.​org/​10.​1007/​s00198-014-2819-x.CrossRefPubMed
22.
Lee DK, Kim HJ, Lee DH. Incidence of deep vein thrombosis and venous thromboembolism following TKA in rheumatoid arthritis verses osteoarthritis: a meta-analysis. PLoS One. 2016;11(12):e0166844. https://​doi.​org/​10.​1371/​journal.​pone.​0166844.CrossRefPubMedPubMedCentral
23.
Izumi M, Migita K, Nakamura M, Jiuchi Y, Sakai T, Yamaguchi T, et al. Risk of venous thromboembolism after total knee arthroplasty in patients with rheumatoid arthritis. J Rheumatol. 2015;42(6):928–34. https://​doi.​org/​10.​3800/​jrheum.​140768.CrossRefPubMed
24.
Kim SC, Schneeweiss S, Liu J, Solomon DH. Risk of venous thromboembolism in patients with rheumatoid arthritis. Arthritis Care Res. 2013;65(10):1600–7. https://​doi.​org/​10.​1002/​acr.​22039.CrossRef
25.
Holmqvist ME, Neovius M, Eriksson J, et al. Risk of venous thromboembolism in patients with rheumatoid arthritis and association with disease duration and hospitalization. JAMA. 2012;308(13):1350–6. https://​doi.​org/​10.​1001/​2012.​jama.​11741.CrossRefPubMed
26.
Wong LE, Bass AR. Postoperative risk of venous thromboembolism in rheumatic disease patients. Curr Rheumtol Rep. 2015;17(2):11. https://​doi.​org/​10.​1007/​s11926-014-0488-6.CrossRef
27.
Gleason LJ, Benton EA, Alvarez-Nebreda ML, et al. FRAIL questionnaire screening tool and short-term outcomes in geriatric fracture patients. JAMDA. 2017;18:1082–6. https://​doi.​org/​10.​1016/​j.​jamda.​2017.​07.​005.PubMedCrossRef
28.
Wasserman BR, Moskovich R, Razi AE. Rheumatoid arthritis of the cervical spine—clinical considerations. Bull NYU Hosp Jt Dis. 2011;69(2):136–48.PubMed
29.
Lee JK, Choi CH. Total knee arthroplasty in rheumatoid arthritis. Knee Surg Relat Res. 2012;24(1):1–6.CrossRefPubMedPubMedCentral
30.
Brasington RD Jr. Rheumatoid arthritis and other synovial disorders “clinical features of rheumatoid arthritis” section 6, Chapter 85. 2015. pp. 704–712.
31.
Dockery KM, Sismarnis A, Abedi E. Rheumatoid Arthritis of the larynx: the importance of early diagnosis and corticosteroid therapy. South Med J. 1991;84(1):95–6.CrossRefPubMed
32.
Wattenmaker I, Conception M, Hibberd P, Lipson S. Upper airway obstruction and perioperative management of the airway in patients managed with posterior operations on the cervical spine for rheumatoid arthritis. J Bone Joint Surg Am. 1994;76(3):360–5.CrossRefPubMed
33.
Ishie S, Ito H, Azukizawa M, Furu M, Ishikawa M, Ogino H, et al. Delayed wound healing after forefoot surgery in patients with rheumatoid arthritis. Mod Rheumatol. 2015;25(3):367–72. https://​doi.​org/​10.​3109/​14397595.​2014.​966975.​ CrossRefPubMed
34.
Kadota Y, Nishida K, Hashizume K, Nasu Y, Nakahara R, Kanazawa T, et al. Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients. Mod Rheumatol. 2016;26(1):68–74. https://​doi.​org/​10.​3109/​14397595.​2015.​1073133.CrossRefPubMed
35.
Koyama K, Ohba T, Ebata S, Haro H. Postoperative surgical infection after spinal surgery in rheumatoid arthritis. Orthopedics. 2016;39(3):e430–3. https://​doi.​org/​10.​3928/​01477447-20160404-05.CrossRefPubMed
36.
Cordtz RL, Hawley S, Priero-Alhambra D, et al. Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time-series analysis using nationwide Danish healthcare registers. Ann Rheum Dis. 2018;77(5):684–9. https://​doi.​org/​10.​1136/​annrheumdis-2017-2122424.CrossRefPubMed
37.
Ravi B, Escott B, Shah PS, Jenkinson R, Chahal J, Bogoch E, et al. A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis verses for osteoarthritis. Arthritis Rheum. 2012;64(12):3839–49. https://​doi.​org/​10.​1002/​art.​37690.CrossRefPubMed
38.
Lee HI, Lee KH, Koh KH, Park MJ. Long-term results of arthroscopic wrist synovectomy in rheumatoid arthritis. J Hand Surg [Am]. 2014;39(7):1295–300. https://​doi.​org/​10.​1016/​j.​jhsa.​2014.​04.​022.CrossRef
39.
Aulakh TS, Kuiper JH, Dixey J, et al. Hip resurfacing for rheumatoid arthritis: independent assessment of 11-year results from an international register. Int Orthod. 2011;35(6):803–8. https://​doi.​org/​10.​1007/​s00264-010-1046-0.CrossRef
40.
Kanbe K, Chiba J, Inoue Y, et al. Analysis of clinical factors related to the efficacy of shoulder arthroscopic synovectomy plus capsular release in patients with rheumatoid arthritis. Eur J Orthop Surg Traumatol. 2015;25(3):451–5. https://​doi.​org/​10.​1007/​s00590-014-1570-5.CrossRefPubMed
41.
Niki H, Hirano T, Akiyama Y, Mitsui H, Fujiya H. Ling-term outcome of joint-preserving surgery by combination metatarsal osteotomies for shortening for forefoot deformity patients with rheumatoid arthritis. Mod Rheumatol. 2015;25(5):683–8. https://​doi.​org/​10.​3109/​14397595.​2015.​1008672.CrossRefPubMed
42.
Nikiphorou E, Morris S, Dixey J, Williams PL, Kiely P, et al. The effect of disease severity and comorbidity on length of stay for orthopedic surgery in rheumatoid arthritis: results from 2 UK Inception Cohorts, 1986-2012. J Rheumatol. 2015;42(5):778–85. https://​doi.​org/​10.​3899/​jrheum.​141049.CrossRefPubMed
43.
• Iwata T, Ito H, Furu M, Hashimoto M, et al. Systemic effects of surgical intervention on disease severity, daily function, and medications in patients with rheumatoid arthritis. Scand J Rheumatol. 2016;45(5):356–62. https://​doi.​org/​10.​3109/​03009742.​2015.​1124918. A prospective cohort study of rheumatoid arthritis patients who underwent arthroplasty was conducted and showed clinically significant improvement on the 28-joint count Disease Activity Score based on erythrocyte sedimentation rate and modified Health Assessment Questionnaire at 6 and 12 months postoperatively. CrossRefPubMed