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Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, Gewurz-Singer O, Giles JT, Johnson B, Lee S, Mandl LA, Mont MA, Sculco P, Sporer S, Stryker L, Turgunbaev M, Brause B, Chen AF, Gililland J, Goodman M, Hurley-Rosenblatt A, Kirou K, Losina E, MacKenzie R, Michaud K, Mikuls T, Russell L, Sah A, Miller AS, Singh JA, Yates A. 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. [PMID: 28629905 DOI: 10.1016/j.arth.2017.05.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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.
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Affiliation(s)
- Susan M Goodman
- 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.
| | - Bryan Springer
- Bryan Springer, MD: OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
| | - Gordon Guyatt
- Gordon Guyatt, MD: McMaster University, Hamilton, Ontario, Canada
| | | | - Vinod Dasa
- Vinod Dasa, MD: Louisiana State University, New Orleans
| | - Michael George
- Michael George, MD: University of Pennsylvania, Philadelphia
| | | | - Jon T Giles
- Jon T. Giles, MD, MPH: Columbia University, New York, New York
| | - Beverly Johnson
- Beverly Johnson, MD: Albert Einstein College of Medicine, Bronx, New York
| | - Steve Lee
- Steve Lee, DO: Kaiser Permanente, Fontana, California
| | - Lisa A Mandl
- 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
| | | | - Peter Sculco
- 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
- Scott Sporer, MD: Midwest Orthopaedics at Rush, Chicago, Illinois
| | - Louis Stryker
- Louis Stryker, MD: University of Texas Medical Branch, Galveston
| | - Marat Turgunbaev
- Marat Turgunbaev, MD, MPH, Amy S. Miller: American College of Rheumatology, Atlanta, Georgia
| | - Barry Brause
- 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
- Antonia F. Chen, MD, MBA: Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Mark Goodman
- Mark Goodman, MD, Adolph Yates, MD: University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Kyriakos Kirou
- 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
- Elena Losina, PhD: Brigham and Women's Hospital, Boston, Massachusetts
| | - Ronald MacKenzie
- 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
- Kaleb Michaud, PhD: National Data Bank for Rheumatic Diseases, Wichita, Kansas and University of Nebraska Medical Center, Omaha
| | - Ted Mikuls
- Ted Mikuls, MD, MSPH: University of Nebraska Medical Center, Omaha
| | - Linda Russell
- 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
- Alexander Sah, MD: Dearborn-Sah Institute for Joint Restoration, Fremont, California
| | - Amy S Miller
- Marat Turgunbaev, MD, MPH, Amy S. Miller: American College of Rheumatology, Atlanta, Georgia
| | | | - Adolph Yates
- Mark Goodman, MD, Adolph Yates, MD: University of Pittsburgh, Pittsburgh, Pennsylvania
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Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, Gewurz-Singer O, Giles JT, Johnson B, Lee S, Mandl LA, Mont MA, Sculco P, Sporer S, Stryker L, Turgunbaev M, Brause B, Chen AF, Gililland J, Goodman M, Hurley-Rosenblatt A, Kirou K, Losina E, MacKenzie R, Michaud K, Mikuls T, Russell L, Sah A, Miller AS, Singh JA, Yates A. 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. [PMID: 28620948 DOI: 10.1002/art.40149] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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.
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Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery/Weill Cornell Medicine, New York, New York
| | - Bryan Springer
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
| | | | | | | | | | | | | | | | - Steve Lee
- Kaiser Permanente, Fontana, California
| | - Lisa A Mandl
- Hospital for Special Surgery/Weill Cornell Medicine, New York, New York
| | | | - Peter Sculco
- Hospital for Special Surgery/Weill Cornell Medicine, New York, New York
| | | | | | | | - Barry Brause
- Hospital for Special Surgery/Weill Cornell Medicine, New York, New York
| | - Antonia F Chen
- Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Mark Goodman
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Kyriakos Kirou
- Hospital for Special Surgery/Weill Cornell Medicine, New York, New York
| | - Elena Losina
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Ronald MacKenzie
- Hospital for Special Surgery/Weill Cornell Medicine, New York, New York
| | - Kaleb Michaud
- National Data Bank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha
| | - Ted Mikuls
- University of Nebraska Medical Center, Omaha
| | - Linda Russell
- Hospital for Special Surgery/Weill Cornell Medicine, New York, New York
| | - Alexander Sah
- Dearborn-Sah Institute for Joint Restoration, Fremont, California
| | - Amy S Miller
- American College of Rheumatology, Atlanta, Georgia
| | | | - Adolph Yates
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, Gewurz‐Singer O, Giles JT, Johnson B, Lee S, Mandl LA, Mont MA, Sculco P, Sporer S, Stryker L, Turgunbaev M, Brause B, Chen AF, Gililland J, Goodman M, Hurley‐Rosenblatt A, Kirou K, Losina E, MacKenzie R, Michaud K, Mikuls T, Russell L, Sah A, Miller AS, Singh JA, Yates A. 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 Care Res (Hoboken) 2017. [DOI: 10.1002/acr.23274] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Susan M. Goodman
- Hospital for Special Surgery/Weill Cornell MedicineNew York New York
| | - Bryan Springer
- OrthoCarolina Hip and Knee CenterCharlotte North Carolina
| | | | | | | | | | | | | | | | | | - Lisa A. Mandl
- Hospital for Special Surgery/Weill Cornell MedicineNew York New York
| | | | - Peter Sculco
- Hospital for Special Surgery/Weill Cornell MedicineNew York New York
| | | | | | | | - Barry Brause
- Hospital for Special Surgery/Weill Cornell MedicineNew York New York
| | - Antonia F. Chen
- Rothman Institute, Thomas Jefferson University HospitalPhiladelphia Pennsylvania
| | | | | | | | - Kyriakos Kirou
- Hospital for Special Surgery/Weill Cornell MedicineNew York New York
| | - Elena Losina
- Brigham and Women's HospitalBoston Massachusetts
| | - Ronald MacKenzie
- Hospital for Special Surgery/Weill Cornell MedicineNew York New York
| | - Kaleb Michaud
- National Data Bank for Rheumatic Diseases, Wichita, Kansas and University of Nebraska Medical CenterOmaha
| | - Ted Mikuls
- University of Nebraska Medical CenterOmaha
| | - Linda Russell
- Hospital for Special Surgery/Weill Cornell MedicineNew York New York
| | - Alexander Sah
- Dearborn‐Sah Institute for Joint RestorationFremont California
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