Variability in the Preoperative Rheumatoid Arthritis Medication Management in Hand Surgery

Purpose Preoperative management of biological disease modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) undergoing hand surgery is a subject of ongoing debate. While consensus supports continuation of corticosteroids and conventional synthetic DMARDs, no definitive guidelines exist for bDMARDs. This study aimed to characterize the degree of perioperative medication management variability among patients with RA undergoing hand surgery and to examine whether continuation of bDMARD therapy is associated with an increased risk of postoperative surgical site infection. Methods A retrospective chart review was conducted at a single academic institution of patients with RA who underwent hand surgery between June 2015 and May 2020. Perioperative medication continuation rates were calculated for corticosteroids, conventional synthetic DMARDs, and bDMARDs. Results Of 171 patients included, 157 (92%) were on pharmacological therapy at the time of surgery. Continuation rates were 82% for corticosteroids, 73% for conventional synthetic DMARDs, and 70% for bDMARDs. Six patients (3.5%) developed a surgical site infection within 30 days. Conclusions Perioperative bDMARD management in patients with RA undergoing hand surgery is variable and lacks standardization. Prospective, multicenter studies are needed to establish evidence-based guidelines for this population. Study type Retrospective cohort study. Type of study/level of evidence Therapeutic III.