Susan M Goodman1, Bryan Springer2, Gordon Guyatt3, Matthew P Abdel4, Vinod Dasa5, Michael George6, Ora Gewurz-Singer7, Jon T Giles8, Beverly Johnson9, Steve Lee10, Lisa A Mandl1, Michael A Mont11, Peter Sculco1, Scott Sporer12, Louis Stryker13, Marat Turgunbaev14, Barry Brause1, Antonia F Chen15, Jeremy Gililland16, Mark Goodman17, Arlene Hurley-Rosenblatt18, Kyriakos Kirou1, Elena Losina19, Ronald MacKenzie1, Kaleb Michaud20, Ted Mikuls21, Linda Russell1, Alexander Sah22, Amy S Miller14, Jasvinder A Singh23, Adolph Yates17. 1. Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. 2. OrthoCarolina Hip and Knee Center, Charlotte, North Carolina. 3. McMaster University, Hamilton, Ontario, Canada. 4. Mayo Clinic, Rochester, Minnesota. 5. Louisiana State University, New Orleans. 6. University of Pennsylvania, Philadelphia. 7. University of Michigan, Ann Arbor. 8. Columbia University, New York, New York. 9. Albert Einstein College of Medicine, Bronx, New York. 10. Kaiser Permanente, Fontana, California. 11. Cleveland Clinic, Cleveland, Ohio. 12. Midwest Orthopaedics at Rush, Chicago, Illinois. 13. University of Texas Medical Branch, Galveston. 14. American College of Rheumatology, Atlanta, Georgia. 15. Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. 16. University of Utah, Salt Lake City. 17. University of Pittsburgh, Pittsburgh, Pennsylvania. 18. Rockefeller University, New York, New York. 19. Brigham and Women's Hospital, Boston, Massachusetts. 20. National Data Bank for Rheumatic Diseases, Wichita, Kansas and University of Nebraska Medical Center, Omaha. 21. University of Nebraska Medical Center, Omaha. 22. Dearborn-Sah Institute for Joint Restoration, Fremont, California. 23. University of Alabama at Birmingham.
Abstract
OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.
OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.
Authors: Susan M Goodman; Serene Z Mirza; Edward F DiCarlo; Diyu Pearce-Fisher; Meng Zhang; Bella Mehta; Laura T Donlin; Vivian P Bykerk; Mark P Figgie; Dana E Orange Journal: Arthritis Care Res (Hoboken) Date: 2020-05-14 Impact factor: 4.794