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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.
J Arthroplasty. 2017 09; 32(9):2628-2638.JA

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

Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York. Electronic address: goodmans@hss.edu.Bryan Springer, MD: OrthoCarolina Hip and Knee Center, Charlotte, North Carolina.Gordon Guyatt, MD: McMaster University, Hamilton, Ontario, Canada.Matthew P. Abdel, MD: Mayo Clinic, Rochester, Minnesota.Vinod Dasa, MD: Louisiana State University, New Orleans.Michael George, MD: University of Pennsylvania, Philadelphia.Ora Gewurz-Singer, MD: University of Michigan, Ann Arbor.Jon T. Giles, MD, MPH: Columbia University, New York, New York.Beverly Johnson, MD: Albert Einstein College of Medicine, Bronx, New York.Steve Lee, DO: Kaiser Permanente, Fontana, California.Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Michael A. Mont, MD: Cleveland Clinic, Cleveland, Ohio.Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Scott Sporer, MD: Midwest Orthopaedics at Rush, Chicago, Illinois.Louis Stryker, MD: University of Texas Medical Branch, Galveston.Marat Turgunbaev, MD, MPH, Amy S. Miller: American College of Rheumatology, Atlanta, Georgia.Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Antonia F. Chen, MD, MBA: Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.Jeremy Gililland, MD: University of Utah, Salt Lake City.Mark Goodman, MD, Adolph Yates, MD: University of Pittsburgh, Pittsburgh, Pennsylvania.Arlene Hurley-Rosenblatt, ANP: Rockefeller University, New York, New York.Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Elena Losina, PhD: Brigham and Women's Hospital, Boston, Massachusetts.Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Kaleb Michaud, PhD: National Data Bank for Rheumatic Diseases, Wichita, Kansas and University of Nebraska Medical Center, Omaha.Ted Mikuls, MD, MSPH: University of Nebraska Medical Center, Omaha.Susan M. Goodman, MD, Lisa A. Mandl, MD, MPH, Peter Sculco, MD, Barry Brause, MD, Kyriakos Kirou, MD, Ronald MacKenzie, MD, Linda Russell, MD: Hospital for Special Surgery/Weill Cornell Medicine, New York, New York.Alexander Sah, MD: Dearborn-Sah Institute for Joint Restoration, Fremont, California.Marat Turgunbaev, MD, MPH, Amy S. Miller: American College of Rheumatology, Atlanta, Georgia.Jasvinder A. Singh, MBBS, MPH: University of Alabama at Birmingham.Mark Goodman, MD, Adolph Yates, MD: University of Pittsburgh, Pittsburgh, Pennsylvania.

Pub Type(s)

Consensus Development Conference
Journal Article
Practice Guideline
Systematic Review

Language

eng

PubMed ID

28629905

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." The Journal of Arthroplasty, vol. 32, no. 9, 2017, pp. 2628-2638.
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. J Arthroplasty. 2017;32(9):2628-2638.
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. The Journal of Arthroplasty, 32(9), 2628-2638. https://doi.org/10.1016/j.arth.2017.05.001
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. J Arthroplasty. 2017;32(9):2628-2638. PubMed PMID: 28629905.
* 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 - 2016/09/26/received PY - 2017/04/28/accepted PY - 2017/6/21/pubmed PY - 2018/4/18/medline PY - 2017/6/21/entrez SP - 2628 EP - 2638 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 9 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 - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28629905/2017_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://linkinghub.elsevier.com/retrieve/pii/S0883-5403(17)30401-1 DB - PRIME DP - Unbound Medicine ER -