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Influence of methotrexate on the frequency of postoperative infectious complications in patients with rheumatoid
1Service d'Immuno-Rhumatologie, CHU, University of Montpellier, France.
Objective:
To evaluate the influence of methotrexate (MTX) on the frequency of postoperative complications in patients with rheumatoid arthritis (RA).
Methods:
We conducted a randomized unblinded prospective study in 64 patients with RA treated with MTX and who underwent orthopedic surgery. Two groups of patients were constituted: in Group A (32 patients), MTX was interrupted 7 days before the surgery; in Group B (32 patients), MTX was not discontinued.
Results:
Fifty surgical procedures were performed in Group A and 39 procedures in Group B. No postoperative infection was observed in any group. A prolonged wound healing was noticed in 6 cases in Group A and in 4 cases in Group B (not significant).
Conclusion:
We suggest that the interruption of MTX is not required in patients with RA when an orthopedic surgical treatment is planned. However a large prospective study is needed to make a definitive conclusion.
Insights
Methotrexate (MTX) interruption is not necessary for patients with rheumatoid arthritis (RA) undergoing orthopedic surgery. This study found no significant difference in postoperative complications between patients who stopped MTX and those who continued it.
Area of Science:
- Rheumatology
- Orthopedic Surgery
- Pharmacology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease often requiring surgical intervention.
- Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD) used in RA management.
- The impact of continuing MTX during orthopedic surgery on patient outcomes is not fully understood.
Purpose of the Study:
- To investigate the effect of perioperative methotrexate (MTX) discontinuation on postoperative complications in rheumatoid arthritis (RA) patients undergoing orthopedic surgery.
- To compare complication rates between RA patients who temporarily stopped MTX and those who continued MTX treatment around the time of surgery.
Main Methods:
- A prospective, randomized, unblinded study involving 64 RA patients scheduled for orthopedic surgery.
- Patients were divided into two groups: Group A (32 patients) had MTX discontinued 7 days pre-surgery, while Group B (32 patients) continued MTX treatment.
- Postoperative complications, including surgical site infections and wound healing issues, were monitored.
Main Results:
- No surgical site infections were reported in either group.
- Prolonged wound healing occurred in 6 patients in Group A and 4 patients in Group B, a difference that was not statistically significant.
- Fifty surgical procedures were performed in Group A and 39 in Group B.
Conclusions:
- Perioperative MTX discontinuation does not appear to be essential for RA patients undergoing orthopedic procedures.
- Continuing MTX during orthopedic surgery may not increase the risk of common postoperative complications.
- Further large-scale prospective studies are recommended to confirm these findings and establish definitive guidelines.