FRI0151
STEROIDS AND LEFLUNOMIDE, NOT BIOLOGICS, ARE THE MAJOR RISK FACTORS FOR INFECTION FOLLOWING TOTAL JOINT ARTHROPLASTY
R. Somayaji 1,*C. Barnabe 1L. Martin 1
1Medicine, University Of Calgary, Calgary, Canada
Background: Rheumatoid Arthritis (RA) patients are at risk for infectious complications following orthopaedic procedures due to underlying comorbidities and RA treatment. The effect of biologic therapies on the risk for infection is still controversial, with conflicting evidence from multiple investigators (1).
Objectives: To determine whether biologic therapies increase the risk of post-operative infection (surgical site or any site) in RA or adult juvenile idiopathic arthritis (JIA) patients undergoing hip or knee total joint arthroplasty (TJA).
Methods: Administrative data from the Calgary Zone of Alberta Health Services identified all RA or adult JIA patients who underwent a hip or knee TJA between January 1/2000 and December 31/2010. Clinical data, surgical details, post-operative infections and post-operative course (minimum 1 year follow-up) was extracted for each patient from the hospital chart.
Results: A total of 236 patients (71% female, mean age 62 years, median BMI 27.7) underwent 347 orthopedic procedures. Comorbidities included hypertension (44%), diabetes (10%), coronary artery disease (15%), smoking (13%) and obesity (38%). Almost all (98%) of patients received pre-operative antibiotics. Surgical site infections occurred in 7 procedures, and other site infections (urinary tract, respiratory, abdominal) in 4 procedures. The relative risk of a post-operative infection was not increased for patients on biologic therapies relative to those on DMARDs alone. Patients on leflunomide or on steroids (dose >15 mg/day) had the highest risk for post-operative infection (Table 1). Underlying comorbidities did not affect the risk of infection (Table 1).
Table 1. Relative Risk for Infection Post-Total Joint Arthroplasty in RA
Variable |
Relative Risk (95%CI; p value) |
|
Biologic Therapy |
0.95 (0.2-4.3; 0.94) |
|
Any steroid therapy |
2.2 (1.4-3.5; 0.01) |
|
Combination steroids and biologic |
1.8 (0.3-12.3; 0.55) |
|
Steroids > 15 mg/day |
18.3 (5.0-67.2; <0.001) |
|
Methotrexate |
0.2 (0.1-1.5; 0.05) |
|
Leflunomide |
3.3 (1.2-9.1; 0.03) |
|
Current Smoker |
0.7 (0.1-4.7; 0.72) |
|
Obesity |
0.7 (0.3-1.9; 0.46) |
|
Hypertension |
0.9 (0.4-1.9; 0.71) |
|
Coronary Artery Disease |
1.9 (0.7-5.2; 0.23) |
|
Combination DMARDs, Diabetes |
No events |
Conclusions: Biologic therapy and underlying comorbidities do not confer an increased risk of post-operative infection in RA patients undergoing hip or knee TJA. Moderate to high dose steroids and leflunomide therapy do significantly increase the risk of infection.
References: 1. Goh L, Jewell T, Laversuch C, Samanta A. Should anti-TNF therapy be discontinued in rheumatoid arthritis patients undergoing elective orthopaedic surgery? A systematic review of the evidence. Rheumatol Int. 2012 Jan;32(1):5-13.
Disclosure of Interest: None Declared