Perioperative Biologic and Targeted DMARDs in Patients with Rheumatic Diseases Undergoing Orthopedic Surgery: A Systematic Review and Meta-Analysis.
Zenat Khired, Mohamed Abdelrazek, Maamon Aljonaid et al.
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In 30 seconds
This systematic review and meta-analysis assessed perioperative continuation versus withholding of biologic and targeted synthetic DMARDs in patients with inflammatory rheumatic diseases undergoing orthopedic surgery. It included 67 studies, with 42 contributing quantitative data and 51,394 unique patients. Continuation was associated with increased surgical-site infection risk (corrected OR 1.27; 95% CI 1.12-1.44), while disease flare risk was lower (OR 0.41; 95% CI 0.29-0.58). The analysis also found a non-significant trend toward higher periprosthetic joint infection risk and lower perioperative CRP and IL-6 levels with continuation.
Key findings
- Continuation was associated with increased surgical-site infection risk (corrected OR 1.27; 95% CI 1.12-1.44).
- Continuation was associated with reduced disease flare risk (OR 0.41; 95% CI 0.29-0.58).
- Periprosthetic joint infection showed a non-significant trend toward increase after correction (corrected OR 1.24; 95% CI 0.88-1.75).
- Continuation was associated with lower perioperative CRP and IL-6 levels.
Why it matters
Perioperative DMARD decisions involve competing outcomes: infection and disease flare. These pooled findings quantify that trade-off across a large patient pool and indicate that continuation is not uniformly beneficial or harmful. The reported biomarker reductions also matter when interpreting inflammatory markers around surgery, since lower levels may accompany continued treatment.
What to keep in mind
The review combined randomized and observational studies, and the abstract does not report study-level certainty or results by individual drug. The pooled associations therefore may not apply equally across agents or patient groups.