Top American rheumatologists and orthopedic surgeons have collaborated for the first time to on guidelines aimed at reducing the risk of joint infection when a juvenile arthritis patient has to have a hip or knee replacement.
Joints of patients with juvenile arthritis can be severely damaged, making walking difficult to impossible. Joint replacement is an option in these cases, with the hip and knee the ones most commonly replaced.
Replacing a joint can relieve teens’ pain and restore function, but the surgery carries a risk of joint infection.
The guidelines note that doctors can manage the risk with the careful use of anti-rheumatic medications just before and just after surgery.
They include eight recommendations on using, stopping and restarting treatments for rheumatic diseases, which include juvenile idiopathic arthritis, spondyloarthritis and systemic lupus erythematosus. They also cover optimal doses of the glucocorticoids used in the treatment.
“Joint infection remains one of the most common reasons for failure of hip and knee replacement,” Dr. Bryan D. Springer, a co-principal investigator of the guideline project, said in a news release. “Because periprosthetic joint infections are associated with such high morbidity [the development of a disease] and mortality, we felt there was a dire need for perioperative management recommendations that could be subscribed to by both disciplines in order to provide arthritis patients with better outcomes.”
Among recommendations aimed at reducing the risk of a joint infection:
• Take patients with inflammatory arthritis off medication before surgery.
• Take patients with juvenile idiopathic arthritis, rheumatoid arthritis, or spondyloarthritis off tofacitinib at least a week before surgery. Tofacitinib is marketed under the brand names Xeljanz and Jakvinus.
• Take lupus patients off rituximab or belimumab before surgery. Rituximab is marketed under the name Rituxan and other labels. Belimumab is marketed under the brand name Benlysta.
A patients panel contributed to the creation of the guidelines. They were included to make sure the recommendations reflected patients’ concerns and preferences.
“There was a very clear message from the patient panel that they were willing to deal with flares if it meant reducing their likelihood for infections and other complications,” said Dr. Susan M. Goodman, the other co-principal investigator of the project.
The guidelines can be found here.