Wound Healing with Medications for Rheumatoid Arthritis in Hand Surgery

Introduction. Medications used to treat rheumatoid arthritis, such as corticosteroids, disease-modifying agents (DMARDs), and injectable biological agents (anti-TNFα), may have widespread effects on wound healing. In hand surgery, it is important to balance the risks of poor wound healing from continuing a medication against the risks of a flare of rheumatoid arthritis if a drug is temporarily discontinued. Materials and Methods. A United Kingdom (UK) group of 28 patients had metacarpophalangeal joint replacement surgery in 35 hands (140 wounds). All medication for rheumatoid arthritis was continued perioperatively, except for the injectable biological agents. Results. There were no instances of wound dehiscence or deep infection and only one episode of minor superficial infection. Conclusions. We conclude that provided care is taken to identify and treat any problems promptly, it is appropriate to continue most antirheumatoid medications in the perioperative period during hand surgery to reduce the risk of destabilising the patients' overall rheumatoid disease control. 1. Introduction Hand deformities are common in rheumatoid arthritis (RA), with 45% of patients affected by ulnar drift at the metacarpophalangeal joints (MCPJs) after 5 years of disease activity and with 33% no longer able to work [1]. Surgery is often performed to improve hand function and relieve pain resulting from tendon and joint degeneration. A common procedure is prosthetic metacarpophalangeal joint (MCPJ) replacement for the treatment of ulnar drift and MCPJ subluxation. Many patients are taking a combination of medications, such as analgesia or anti-inflammatory agents in addition to one or more disease-modifying antirheumatic drugs (DMARDs) to manage their systemic disease [2]. There are well-documented concerns in the general literature regarding the use of nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and immunomodulatory medications in the perioperative period, particularly with respect to wound healing problems. However, specific data pertinent to patients with rheumatoid arthritis is relatively sparse, and recommendations are frequently based upon data from other patient groups, such as in transplant surgery and the management of inflammatory bowel disease [3]. There are studies assessing postoperative complications with orthopaedic surgery in patients with RA, but with the exception of methotrexate, the studies are usually small and retrospective [4]. In cases where prosthetic devices are inserted, a wound breakdown or infection can be devastating and