Risk factors of postoperative delayed wound healing in patients with rheumatoid arthritis treated with a biological agent.

Published on May 4, 2021in Modern Rheumatology2.113
· DOI :10.1080/14397595.2020.1790138
Shunji Okita (Okayama University), Hajime Ishikawa12
Estimated H-index: 12
+ 5 AuthorsToshifumi Ozaki57
Estimated H-index: 57
(Okayama University)
Source
Abstract
OBJECTIVES This retrospective study aimed to investigate the risk factors associated with delayed wound healing (DWH) after orthopedic surgery in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs). METHODS We reviewed medical records of 276 orthopedic procedures for 187 RA patients treated with bDMARDs. As a preoperative nutritional status assessment, we evaluated body mass index (BMI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT). We evaluated DAS28-CRP, DAS28-ESR, face scale, global health, and HAQ-DI to assess the disease activity. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors for DWH. RESULTS In 276 procedures, DWH was identified in 24 patients (8.7%). Disease duration, foot and ankle surgery, and pre-operative use of tocilizumab were significant in the univariate analyses. These variables were entered into a multivariate model, and it was revealed that pre-operative use of tocilizumab and procedures in the foot and ankle were associated with an increased risk of DWH. CONCLUSION The current retrospective study suggested that pre-operative use of tocilizumab and procedures in the foot and ankle were risk factors for DWH.
📖 Papers frequently viewed together
2 Citations
3 Citations
1 Citations
References16
Newest
#1Eriko Hasegawa (Niigata University)H-Index: 5
#2Daisuke Kobayashi (Niigata University)H-Index: 14
Last. Hajime IshikawaH-Index: 12
view all 11 authors...
AbstractObjectives: The aim of this study was to identify the risk factors associated with severe infection in RA patients, with a particular focus on the association of the nutritional status.Meth...
2 CitationsSource
#1Ross DiaperH-Index: 1
#2Ernest Wong (QA: Queen Alexandra Hospital)H-Index: 3
Last. Stuart A. MetcalfeH-Index: 8
view all 3 authors...
Abstract Introduction Rheumatoid arthritis (RA) is one of a number of inflammatory arthropathies resulting in foot pain and deformity. Patients with this disease may require surgical intervention as part of their management. Many of these patients are now taking biologic agents which pose several risks to patients in the perioperative phase. The surgical team therefore need to be aware of these associated complications and how to manage these cases. Aim This paper aims to review the current lite...
6 CitationsSource
#1Masahiro TadaH-Index: 11
#2Kentaro Inui (OCU: Osaka City University)H-Index: 12
Last. Tatsuya Koike (OCU: Osaka City University)H-Index: 20
view all 8 authors...
Biological disease-modifying antirheumatic drugs (bDMARDs) have become more popular for treating rheumatoid arthritis (RA). Whether or not bDMARDs increase the postoperative risk of surgical site infection (SSI) has remained controversial. We aimed to clarify the effects of bDMARDs on the outcomes of elective orthopedic surgery. We used multivariate logistic regression analysis to analyze risk factors for SSI and delayed wound healing among 227 patients with RA (mean age, 65.0 years; disease dur...
15 CitationsSource
#1Yasutaka KadotaH-Index: 7
#2Keiichiro Nishida (Okayama University)H-Index: 36
Last. Toshifumi OzakiH-Index: 57
view all 10 authors...
AbstractObjective: To investigate the prevalence and the risk factors of surgical-site infection (SSI) and delayed wound healing (DWH) in patients with rheumatoid arthritis (RA) underwent orthopedic surgery.Methods: We reviewed the records of 1036 elective orthopedic procedures undertaken in RA patients. Risk factors for SSI and DWH were assessed by logistic regression analysis using age, body mass index, disease duration, pre-operative laboratory data, surgical procedure, corticosteroid use, co...
17 CitationsSource
#1Koichiro YanoH-Index: 13
#2Katsunori IkariH-Index: 29
Last. Shigeki MomoharaH-Index: 40
view all 6 authors...
Objectives. Forefoot deformities are common in patients with rheumatoid arthritis (RA) and often require operative treatment. There is a high rate of delayed wound healing after foot surgery, especially among patients with RA. The aim of this study was to identify risk factors of delayed wound healing in RA patients who had undergone forefoot surgery.Methods. This study was a retrospective observational study designed to analyze the outcomes of all consecutive RA patients who had undergone toe a...
11 CitationsSource
Abstract Objective Arthroplasty remains prevalent for patients with rheumatoid arthritis (RA), but outcomes are not equivalent to patients with osteoarthritis, and complications including infection are increased. The objective of this article is to review the current evidence supporting perioperative medication management. Challenges are discussed such as continuing potent disease-modifying therapy (DMARDs) and biologics, which may increase infection risk, versus withholding these medications, w...
40 CitationsSource
#1Hiromu Ito (Kyoto University)H-Index: 49
#2Masayo Kojima (Nagoya City University)H-Index: 33
Last. Hisashi YamanakaH-Index: 75
view all 18 authors...
AbstractObjectives. To evaluate, through a systematic review of the literature, the association between the use of biological disease-modifying antirheumatic drugs (bDMARDs) and surgical site infection (SSI) or wound healing delay after orthopedic surgery in patients with rheumatoid arthritis (RA).Methods. A systematic review of articles indexed in the Cochrane Library, PubMed, and Web of Science from 1992 to 2012 was performed. The search aimed to identify studies describing SSI or wound healin...
19 CitationsSource
#1Ayako KubotaH-Index: 5
#2Masayuki SekiguchiH-Index: 4
Last. Toru SuguroH-Index: 19
view all 5 authors...
AbstractObjectives. The goal of the study was to examine the influence of biological agents on postoperative infections such as surgical site infection (SSI) and late infection in patients with rheumatoid arthritis after total joint arthroplasty at our hospital between January 2006 and December 2011.Methods. The patients were divided into groups with (Bio group, 267 joints) and without (Non-Bio group, 300 joints) treatment with biological agents. We examined the incidence of postoperative infect...
11 CitationsSource
#1Toshio Tanaka (Osaka University)H-Index: 58
#2Tadamitsu Kishimoto (Osaka University)H-Index: 201
Interleukin (IL)-6, a cytokine featuring redundancy and pleiotropic activity, contributes to host defense against acute environmental stress, while dysregulated persistent IL-6 production has been demonstrated to play a pathological role in various autoimmune and chronic inflammatory diseases. Targeting IL-6 is thus a rational approach to the treatment of these diseases. Indeed, clinical trials of tocilizumab, a humanized anti-IL-6 receptor antibody have verified its efficacy and tolerable safet...
192 CitationsSource
#1Masahiko Suzuki (Chiba University)H-Index: 19
#2Keiichiro Nishida (Okayama University)H-Index: 36
Last. Toru Suguro (Toho University)H-Index: 19
view all 14 authors...
Purpose Since biologic agents were introduced to treat rheumatoid arthritis (RA) in 2003, the number of orthopedic surgical procedures under treatment with biologic agents has been increasing in Japan. However, whether biologic agents cause an increase in the prevalence of postoperative complications is as yet unknown. The Committee on Arthritis of the Japanese Orthopedic Association investigated the prevalence of postoperative complications in patients with RA in teaching hospitals in Japan.
25 CitationsSource
Cited By0
Newest