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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 Rheumatol. 2017 08; 69(8):1538-1551.AR

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.

Authors+Show Affiliations

Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.OrthoCarolina Hip and Knee Center, Charlotte, North Carolina.McMaster University, Hamilton, Ontario, Canada.Mayo Clinic, Rochester, Minnesota.Louisiana State University, New Orleans.University of Pennsylvania, Philadelphia.University of Michigan, Ann Arbor.Columbia University, New York, New York.Albert Einstein College of Medicine, Bronx, New York.Kaiser Permanente, Fontana, California.Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Cleveland Clinic, Cleveland, Ohio.Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Midwest Orthopaedics at Rush, Chicago, Illinois.University of Texas Medical Branch, Galveston.American College of Rheumatology, Atlanta, Georgia.Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.University of Utah, Salt Lake City.University of Pittsburgh, Pittsburgh, Pennsylvania.Rockefeller University, New York, New York.Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Brigham and Women's Hospital, Boston, Massachusetts.Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.National Data Bank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha.University of Nebraska Medical Center, Omaha.Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Dearborn-Sah Institute for Joint Restoration, Fremont, California.American College of Rheumatology, Atlanta, Georgia.University of Alabama at Birmingham.University of Pittsburgh, Pittsburgh, Pennsylvania.

Pub Type(s)

Journal Article
Practice Guideline
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28620948

Citation

Goodman, Susan M., et al. "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 & Rheumatology (Hoboken, N.J.), vol. 69, no. 8, 2017, pp. 1538-1551.
Goodman SM, Springer B, Guyatt G, et al. 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 Rheumatol. 2017;69(8):1538-1551.
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 & Rheumatology (Hoboken, N.J.), 69(8), 1538-1551. https://doi.org/10.1002/art.40149
Goodman SM, et al. 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 Rheumatol. 2017;69(8):1538-1551. PubMed PMID: 28620948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Goodman,Susan M, AU - Springer,Bryan, AU - Guyatt,Gordon, AU - Abdel,Matthew P, AU - Dasa,Vinod, AU - George,Michael, AU - Gewurz-Singer,Ora, AU - Giles,Jon T, AU - Johnson,Beverly, AU - Lee,Steve, AU - Mandl,Lisa A, AU - Mont,Michael A, AU - Sculco,Peter, AU - Sporer,Scott, AU - Stryker,Louis, AU - Turgunbaev,Marat, AU - Brause,Barry, AU - Chen,Antonia F, AU - Gililland,Jeremy, AU - Goodman,Mark, AU - Hurley-Rosenblatt,Arlene, AU - Kirou,Kyriakos, AU - Losina,Elena, AU - MacKenzie,Ronald, AU - Michaud,Kaleb, AU - Mikuls,Ted, AU - Russell,Linda, AU - Sah,Alexander, AU - Miller,Amy S, AU - Singh,Jasvinder A, AU - Yates,Adolph, Y1 - 2017/06/16/ PY - 2017/09/26/received PY - 2017/04/28/accepted PY - 2017/6/18/pubmed PY - 2017/8/22/medline PY - 2017/6/17/entrez SP - 1538 EP - 1551 JF - Arthritis & rheumatology (Hoboken, N.J.) JO - Arthritis Rheumatol VL - 69 IS - 8 N2 - 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. SN - 2326-5205 UR - https://www.unboundmedicine.com/medline/citation/28620948/2017_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_ L2 - https://doi.org/10.1002/art.40149 DB - PRIME DP - Unbound Medicine ER -