2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

Susan M. Goodman, Bryan Springer, Gordon Guyatt, Matthew P. Abdel, Vinod Dasa, Michael George, Ora Gewurz-Singer, Jon T. Giles, Beverly Johnson, Steve Lee, Lisa A. Mandl, Michael A. Mont, Peter Sculco, Scott Sporer, Louis Stryker, Marat Turgunbaev, Barry Brause, Antonia F. Chen, Jeremy Gililland, Mark GoodmanArlene Hurley-Rosenblatt, Kyriakos Kirou, Elena Losina, Ronald MacKenzie, Kaleb Michaud, Ted Mikuls, Linda Russell, Alexander Sah, Amy S. Miller, Jasvinder A. Singh, Adolph Yates

Research output: Contribution to journalArticle

34 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1111-1124
Number of pages14
JournalArthritis Care and Research
Volume69
Issue number8
DOIs
StatePublished - Aug 2017

ASJC Scopus subject areas

  • Rheumatology

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    Goodman, S. M., Springer, B., Guyatt, G., Abdel, M. P., Dasa, V., George, M., Gewurz-Singer, O., Giles, J. T., Johnson, B., Lee, S., Mandl, L. A., Mont, M. A., Sculco, P., Sporer, S., Stryker, L., Turgunbaev, M., Brause, B., Chen, A. F., Gililland, J., ... Yates, A. (2017). 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Care and Research, 69(8), 1111-1124. https://doi.org/10.1002/acr.23274