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Influence of steroids and methotrexate on wound complications after elective rheumatoid hand and wrist surgery
Abhilash Jain1, Melinda Witbreuk, Cathy Ball
1Department of Musculoskeletal Surgery and the Kennedy Institute of Rheumatology, Imperial College School of Medicine, Charing Cross Hospital, London, England.
Abstract:
Eighty patients with rheumatoid arthritis who had 129 surgical procedures on the hand and wrist over a 5-year period were reviewed. All patients continued with their usual medication throughout the perioperative period. There were 2 pin track infections and 1 wound infection in patients taking methotrexate alone (3 of 48), 1 wound dehiscence in a patient taking steroids without methotrexate (1 of 30), 1 wound infection in a patient taking both drugs (1 of 30), and 2 wound infections in patients taking neither of these drugs (2 of 21). There was no statistically significant risk of wound infection or breakdown in patients taking methotrexate or steroids or both. Rheumatoid patients with diabetes had an increased risk of wound infection (33%) compared with patients without (3.3%). No disease flare-ups occurred within 3 months of surgery. We recommend that these drugs be continued throughout the surgical and postoperative rehabilitation period.
Insights
For rheumatoid arthritis patients undergoing surgery, continuing methotrexate and steroids perioperatively does not increase infection risk. However, diabetes significantly elevates the risk of surgical wound infections.
Area of Science:
- Orthopedics
- Rheumatology
- Infectious Disease
Background:
- Rheumatoid arthritis (RA) patients often require surgery, particularly for hand and wrist deformities.
- The use of immunosuppressive medications like methotrexate and steroids in RA patients raises concerns about surgical site infection (SSI) risk.
- Optimal perioperative management for RA patients on these medications is crucial.
Purpose of the Study:
- To evaluate the risk of surgical wound complications in rheumatoid arthritis patients undergoing hand and wrist surgery.
- To determine the impact of perioperative methotrexate and corticosteroid use on infection and wound breakdown rates.
- To identify patient factors, such as diabetes, associated with increased surgical risk.
Main Methods:
- Retrospective review of 80 rheumatoid arthritis patients undergoing 129 hand and wrist surgical procedures over 5 years.
- Analysis of surgical site infection and wound dehiscence rates based on perioperative medication use (methotrexate, steroids, or both).
- Comparison of infection rates between diabetic and non-diabetic RA patients.
Main Results:
- No statistically significant increase in wound infection or breakdown was observed in patients taking methotrexate, steroids, or both.
- Infection rates were 3/48 for methotrexate alone, 1/30 for steroids alone, 1/30 for both, and 2/21 for neither drug.
- Patients with diabetes had a significantly higher risk of wound infection (33%) compared to those without diabetes (3.3%).
- No rheumatoid arthritis disease flare-ups occurred within 3 months post-surgery.
Conclusions:
- Perioperative continuation of methotrexate and corticosteroids is safe for rheumatoid arthritis patients undergoing hand and wrist surgery.
- Diabetes is a significant risk factor for surgical wound infections in this patient population.
- Recommendations support continuing these disease-modifying antirheumatic drugs (DMARDs) throughout the perioperative period.
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