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The place of methotrexate perioperatively in elective orthopedic surgeries in patients with rheumatoid arthritis
Herwig Pieringer1, Ulrike Stuby, Georg Biesenbach
1Section of Rheumatology, 2nd Department of Medicine, General Hospital Linz, Krankenhausstr. 9, Linz, 4020, Austria. herwigpi@yahoo.com
Abstract:
No clear consensus exists on whether methotrexate (MTX) should be continued or whether this therapy should be discontinued for a few weeks in patients with rheumatoid arthritis (RA) undergoing surgery. Continued MTX therapy may impair wound healing, but discontinuation of the therapy may increase the risk of flares. In this article we review published data on the perioperative management of MTX in patients with RA undergoing elective orthopedic surgery. Eight papers on this topic could be identified. These studies compare continued vs. discontinued MTX therapy or MTX therapy vs. therapies other than MTX. Summing up the published data, continued MTX therapy appears to be safe perioperatively and seems also to be associated with a reduced risk of flares. None of the examined papers addresses the issue of safety in connection with comorbidities, age or high doses of MTX.
Insights
For rheumatoid arthritis (RA) patients undergoing surgery, continuing methotrexate (MTX) is safe and may reduce disease flares. Discontinuing MTX might impair wound healing, but continuing it poses no increased perioperative risks.
Area of Science:
- Rheumatology
- Pharmacology
- Surgical Management
Background:
- Methotrexate (MTX) is a common treatment for rheumatoid arthritis (RA).
- Perioperative management of MTX in RA patients undergoing surgery lacks a clear consensus.
- Concerns exist regarding wound healing with continued MTX versus flare risk with discontinuation.
Purpose of the Study:
- To review published data on the perioperative management of MTX in RA patients undergoing elective orthopedic surgery.
- To evaluate the safety and efficacy of continuing versus discontinuing MTX around the time of surgery.
Main Methods:
- Systematic review of published literature.
- Identification and analysis of eight relevant studies.
- Comparison of outcomes between continued MTX therapy and discontinued MTX therapy or alternative treatments.
Main Results:
- Continued MTX therapy appears safe during the perioperative period for RA patients.
- Continuing MTX was associated with a reduced risk of RA flares.
- No studies addressed safety concerning comorbidities, age, or high MTX doses.
Conclusions:
- Perioperative continuation of methotrexate is a safe strategy for rheumatoid arthritis patients undergoing elective orthopedic surgery.
- Continuing MTX may help prevent disease flares without compromising surgical outcomes.
- Further research is needed on specific patient subgroups and higher MTX doses.
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