RA Meds Didn't Boost Infection Risk

DMARDs and biologics for rheumatoid arthritis were not associated with increased infection risk after surgery

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Avoiding infection is a big concern for patients who are planning on having surgery. And new research sheds light on how rheumatoid arthritis patients should prepare for upcoming surgery.

It was previously thought that medications to help manage rheumatoid arthritis might be a risk factor for infection after surgery.

However, this new study found that continuing to take rheumatoid arthritis medicine before and after surgery did not increase the risk for infection.

The researchers concluded that there did not seem to be a benefit to stopping arthritis treatment to avoid infection after surgery.

"Tell your surgeon about all the medications you're taking."

Bernard Ng, MD, associate professor of medicine and chief of rheumatology at VA Puget Sound HCS, and colleagues conducted this study to see if medications for rheumatoid arthritis affected the risk of developing an infection after surgery.

Rheumatoid arthritis is a painful disease in which joints become tender, swollen and stiff. People with rheumatoid arthritis may have difficulty moving and carrying out day-to-day tasks.

Types of medications that can manage the effects of rheumatoid arthritis include disease modifying antirheumatic drugs (DMARDs) such as methotrexate (brand name Trexall) and biologics such as adalimumab (brand name Humira), etanercept (brand name Enbrel) and rituximab (brand name Rituxan).

Although DMARDs and biologics may be helpful for many people with rheumatoid arthritis, medical professionals have voiced concerns that these medications may increase the risk of infection in patients after surgery by suppressing the immune system.

Wound infections after surgery can be a serious threat to the healing process. Patients who develop infections after surgery may require additional treatment and even further surgery.

To see if DMARDs and biologics were safe to use before surgery, the researchers looked at data from the Veterans Affairs medical database to see which rheumatoid arthritis patients developed infections more frequently.

This study included 6,548 patients who had rheumatoid arthritis, were using DMARDs or biologics and had undergone surgery. 

The researchers then assessed the rate of infection in the 30 days following surgery. Specifically, they compared the infection rates among patients who had stopped using their RA medicine before surgery to those who had continued.

The researchers found that patients with rheumatoid arthritis who continued taking their medications before and after surgery were not at an increased risk for infection after surgery.

In fact, stopping DMARD or biologic use after surgery was associated with infections. However, the authors noted that patients may have been instructed to stop taking the medicine after an infection developed.

The researchers concluded that DMARDs and biologics did not contribute to an increased risk of infection among surgical patients who had rheumatoid arthritis.

The authors of the study noted several limitations. For one, the participants only took one DMARD or biologic, whereas many rheumatoid arthritis patients take several.

The researchers also called for more research to be done on the effects of rheumatoid arthritis treatment on recovery from different kinds of surgery.

This study will be presented at the annual meeting of the American College of Rheumatology on October 26.

The researchers did not disclose any conflicts of interest or funding sources.

Review Date: 
October 24, 2013
Last Updated:
October 28, 2013