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Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy
M T Carpenter1, S G West, S A Vogelgesang
1Department of Medicine, Fitzsimons Army Medical Center, Aurora, Colo. 80045-5000, USA.
Abstract:
The effect of low dose methotrexate (MTX) on postoperative complications in rheumatoid arthritis patients undergoing elective total joint arthroplasty was observed prospectively in 32 patients. Patients were assigned to discontinue MTX the week prior to and during the week of surgery (Group 1, n = 19) or to continue MTX throughout the perioperative period (Group 2, n = 13). Nineteen patients in Group 1 had 26 procedures, with no postoperative infections. Thirteen patients in Group 2 had 16 procedures, with 4 postoperative infections: 2 infected prostheses, 1 infected joint fusion, and 1 deep wound infection (P = .03). No patient had a postoperative flare of rheumatoid arthritis. Temporary discontinuation of MTX prior to joint arthroplasty appears to decrease the risk of postoperative infection.
Insights
Temporarily stopping low-dose methotrexate (MTX) before joint replacement surgery may reduce infection risks for rheumatoid arthritis patients. Continuing MTX perioperatively was linked to higher rates of postoperative complications, including infections.
Area of Science:
- Orthopedics
- Rheumatology
- Infectious Disease
Background:
- Rheumatoid arthritis (RA) patients often require joint arthroplasty.
- Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD) used in RA management.
- The impact of perioperative MTX on surgical site infections (SSIs) in arthroplasty is not fully elucidated.
Purpose of the Study:
- To investigate the effect of continuing or discontinuing low-dose methotrexate (MTX) on postoperative complications in rheumatoid arthritis patients undergoing elective total joint arthroplasty.
Main Methods:
- Prospective observational study of 32 RA patients undergoing elective total joint arthroplasty.
- Group 1 (n=19): Discontinued MTX the week before and during surgery.
- Group 2 (n=13): Continued MTX throughout the perioperative period.
Main Results:
- No postoperative infections occurred in Group 1 (19 patients, 26 procedures).
- Four postoperative infections (2 infected prostheses, 1 infected joint fusion, 1 deep wound infection) occurred in Group 2 (13 patients, 16 procedures) (P = .03).
- No patient experienced a postoperative rheumatoid arthritis flare in either group.
Conclusions:
- Temporary discontinuation of MTX prior to joint arthroplasty appears to decrease the risk of postoperative infection.
- Continuing MTX perioperatively may increase the risk of surgical site infections in RA patients undergoing arthroplasty.
- Further research is warranted to optimize perioperative DMARD management in RA patients undergoing major orthopedic surgery.