Associations update guidelines on perioperative medication use for total joint patients

Editor's Note

The American College of Rheumatology and the American Association of Hip and Knee Surgeons, on February 28, released a summary of their updated guideline for the “Perioperative Management of Antirheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.”

The guideline, which is an update of the organizations’ 2017 joint guideline, includes recommendations for patients with systemic lupus erythematosus, spondyloarthritis, juvenile idiopathic arthritis, rheumatoid arthritis, and other forms of inflammatory arthritis.

It also includes a list of medications patients should continue to take through surgery and a list of medications to withhold before surgery.

Among the recommendations:

• Withhold biologic medications in patients with idiopathic arthritis for a dosing cycle before surgery and scheduling surgery after that dose is due.
• Continue treating patients with severe systemic lupus erythematosus with biologic medications, but withhold them in less severe cases.
• Shorten the time between the last dose of JAK inhibitors and surgery from 7 to 3 days.
• The risks and benefits of continuing treating patients with recently introduced immunosuppressive medications anafrolumab and voclosporic should be discussed by the physician and patient before surgery.