Influences of anti-tumour necrosis factor agents on postoperative recovery in patients with rheumatoid arthritis.

The aim of this study is to investigate the influences of the anti-tumour necrosis factor (TNF) agents infliximab and etanercept on the postoperative recovery of patients with rheumatoid arthritis (RA). We also investigated the effects of biologics on wound healing. Patients with RA were split into a TNF group (n = 39) that underwent 39 operations and were treated with anti-TNF agents, and a non-TNF group (n = 74) that underwent 74 operations and were treated only with conventional disease-modifying antirheumatic drugs. Operations included ankle arthrodesis and total arthroplasty of the hip, knee, elbow, shoulder and ankle. Adverse events (AEs) of surgical wounds, time for complete wound healing, febrile period after operation and recovery parameters after operation (%recovery of haemoglobin (Hb), total protein and albumin at 4 weeks after operation compared with pre-operation levels) were investigated. AEs of surgical wounds occurred in two operations (5.1%) in the TNF group and in five operations (6.8%) in the non-TNF group, but this difference was not statistically significant. There were also no significant differences in the time for complete wound healing and in the length of the febrile period between the two groups. Percentage recovery of Hb was significantly better in the TNF group than in the non-TNF group (96.3% vs. 90.1%, respectively; p < 0.05). These results suggest that the use of anti-TNF agents does not cause specific AEs on surgical wounds after elective orthopaedic operations in RA patients and might improve the percentage recovery of Hb due to its prompt anti-TNF effects.