acp presentation 2012 – steroids and leflunomide, not biologics are the major risk factors for...
TRANSCRIPT
ACP PRESENTATION 2012
– Steroids and Leflunomide, Not Biologics Are The Major
Risk Factors For Infection Following Total Joint
Arthroplasty
Ranjani Somayaji B.Sc.PT., MD
Dis
claim
er Wishing I had one?...
Residency Salary?
Back
gro
und
Rheumatoid arthritis (RA)
patients are at risk for
infectious complications
following orthopedic
procedures due to underlying co-morbidities
& RA treatment The effect of biologic
therapies on the risk of
infections is still controversial…
Goh L, Jewell T, Laversuch C & Smanta A. Should anti-TNF therapy be discontinued in rheumatoid arthritis patients undergoing orthopaedic surgery? A systematic review of the evidence. Rheumatol Int 2012;32:5-13.
Obje
ctiv
e
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
Meth
ods
Subjects: RA/JIA undergoing hip or knee
TJA between January 1,
2000 – December 31,
2010 Total of 381 procedures in
259 patients performed
Demographic + clinical
data collected for up to 1
year
Hyp
oth
esi
s
Patients with RA on biologic
therapy will have an increased
incidence of post-operative
infection following hip or knee
TJA as compared with RA
patients on standard disease
modifying agents…
Table
1
Demographics n=259
Female 71%
Age (mean) 63 years
Smoking 13% current13% past74% never
BMI mean 27.6underweight 5%normal weight 37%overweight 24%obese 33%
Comorbidity Hypertension 43%Diabetes 10%Coronary artery disease 14%Chronic kidney disease 3%
Prednisone Use None 71%1-15 mg/day 27%>15 mg/day 2%
Biologic Use 18%
Resu
lts
– Pa
rt 1
Relative Risk for Infection Following Total Joint Arthroplasty by Therapy
Therapy Infection rates
Relative Risk
Biologics 2/70 0.90 (0.25-3.26)p = 0.8768
Steroids (<15mg/d)
7/106 2.03 (1.23-3.36)*p= 0.0271
Steroids (>15mg/d)
3/7 23.1 (5.79-91.87)p<0.0001
Biologic + Steroid
1/18 1.81(0.26-12.50)p=0.5493
Methotrexate 1/145 0.21 (0.03-1.40)p=0.0312
Leflunomide 3/34 2.98 (1.06-8.39)p=0.0472
Combination DMARDs
0 cases -
Resu
lts
– Pa
rt 2
Relative Risk for Infection Following Total Joint Arthroplasty by Comorbidity
Comorbidity Infection rates
Relative Risk
Current Smoker
1/34 0.93 (0.14-6.26)p=0.9419
Obesity 3/130 0.73 (0.27-1.95)p=0.4983
Hypertension 4/156 0.81 (0.36-1.81)p=0.5807
Coronary Artery Disease
4/54 2.45 (1.06-5.69)p=0.0539
Diabetes 3/42 2.36 (0.85-6.57)p=0.1174
Dis
cuss
ion
Biologic therapy & underlying co-morbidities
do not confer an increased
risk of post-operative
infection in RA patients
undergoing hip or knee
total joint arthroplasty
Moderate to high dose
steroids & leflunomide
increase the risk of infection Limitations… Future studies….
QU
ESTIO
NS?
Thank you to Dr. Liam Martin & Dr. Cheryl
Barnabe