medwireNews: The American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) have issued updated recommendations to guide perioperative use of antirheumatic medications among people with rheumatic diseases undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA).
“This guideline is intended for use by clinicians and patients and balances the risk of flares of disease when medications are withheld versus infection risk attributed to the medications when they are continued,” say the guideline authors, led by Susan Goodman (Hospital for Special Surgery, Weill Cornell Medicine, New York, USA).
The recommendations were developed by a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists on the basis of a systematic literature review. They apply to patients with inflammatory arthritis, juvenile idiopathic arthritis, or systemic lupus erythematosus, and include guidance on conventional DMARDs, biologics, Janus kinase inhibitors, and glucocorticoids.
Goodman and colleagues stress that the ACR–AAHKS guidelines “are not treatment mandates,” but rather “provide the backbone for a shared decision-making process between patient and physician regarding perioperative medication management.”
The recommendations were published simultaneously in Arthritis Care & Research, Arthritis & Rheumatology, and The Journal of Arthroplasty.
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Arthritis Care Res 2022; doi:10.1002/acr.24893
Arthritis Rheumatol 2022; doi:10.1002/art.42140
J Arthroplasty 2022; doi:10.1016/j.arth.2022.05.043