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Perioperative use of methotrexate in patients with rheumatoid arthritis undergoing orthopedic surgery
1Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, USA.
Abstract:
Methotrexate (MTX) is commonly prescribed for the treatment of rheumatoid arthritis. Its use seems to be an independent risk factor for infection with common pathogens and opportunistic organisms. Some rheumatologists and orthopedic surgeons hold the opinion that MTX should be temporarily withheld to lessen the likelihood of postoperative infection or poor wound healing. Alternatively, some clinicians believe that MTX should be continued throughout the perioperative period to avoid flares in rheumatoid arthritis disease activity. There are no definitive studies on which to rely in this decision-making process, but the authors believe that withholding MTX for 2 weeks of the perioperative period is a reasonable and prudent approach.
Insights
Withholding methotrexate (MTX) for two weeks around surgery may reduce infection risk in rheumatoid arthritis patients. This approach balances infection prevention with managing disease activity during the perioperative period.
Area of Science:
- Rheumatology
- Infectious Disease
- Surgical Outcomes
Background:
- Methotrexate (MTX) is a common treatment for rheumatoid arthritis.
- MTX use is linked to an increased risk of infections, including opportunistic pathogens.
- There is ongoing debate regarding perioperative MTX management to balance infection risk and disease control.
Purpose of the Study:
- To evaluate the optimal perioperative management of methotrexate in rheumatoid arthritis patients.
- To determine if withholding MTX influences postoperative infection rates or wound healing.
- To assess the impact of perioperative MTX continuation on rheumatoid arthritis disease flares.
Main Methods:
- This study reviews current clinical opinions and available literature on perioperative methotrexate use.
- It considers the risks of infection and the benefits of disease control.
- The authors propose a recommended management strategy based on clinical judgment.
Main Results:
- No definitive studies currently guide perioperative methotrexate decisions.
- Conflicting opinions exist among rheumatologists and orthopedic surgeons.
- The authors' clinical experience suggests a potential benefit to withholding MTX.
Conclusions:
- Withholding methotrexate for two weeks in the perioperative period is suggested as a prudent approach.
- This strategy aims to mitigate infection risk and promote wound healing.
- Further research is needed to establish definitive guidelines for perioperative MTX management.