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Perioperative Biologic Disease-Modifying Antirheumatic Drugs, Risks of Infections, and Wound Complications in
Jackson M Cathey1, Paige J Carrigan2, Justin Zhang3
1Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
The Journal of Hand Surgery
|April 13, 2026
Summary
Continuing biologic disease-modifying antirheumatic drugs (bDMARDs) during elective hand surgery for rheumatoid arthritis (RA) did not increase surgical site infection (SSI) or wound healing failure risks. This supports current perioperative bDMARD management strategies for RA patients.
Area of Science:
- Rheumatology
- Hand Surgery
- Pharmacology
Background:
- Perioperative management of biologic disease-modifying antirheumatic drugs (bDMARDs) in hand surgery often relies on guidelines from other specialties.
- Understanding the specific risks associated with bDMARDs in rheumatoid arthritis (RA) patients undergoing elective hand surgery is crucial.
Purpose of the Study:
- To estimate the risks of surgical site infections (SSIs) and wound healing failures in RA patients treated with bDMARDs undergoing elective hand surgery.
- To compare outcomes between patients who continued and discontinued bDMARDs perioperatively.
Main Methods:
- A retrospective cohort study using the TriNetX Research Network.
- Patients with RA on DMARDs undergoing elective hand surgery were stratified by DMARD type.
- Propensity-score matching was used to compare outcomes between bDMARD continuers and discontinuers.
Main Results:
- Among 2,668 bDMARD users, 908 continued and 1,760 discontinued therapy.
- Matched cohorts (881 per group) showed similar risks for SSIs (2.0% vs 1.5%), wound healing failures (1.4% vs 1.4%), and composite wound morbidity (3.0% vs 2.5%).
- Perioperative bDMARD continuation was linked to lower risks of postoperative disease flares.
Conclusions:
- Perioperative bDMARD continuation in RA patients undergoing elective hand surgery is not associated with increased risks of wound healing failures or SSIs.
- While a modest increase in SSI risk cannot be entirely ruled out due to potential confounding, the findings support current management practices.
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