Perioperative management of biologic disease-modifying antirheumatic drugs in patients with inflammatory rheumatic diseases undergoing total joint arthroplasty: A nationwide population-based cohort study from Taiwan.

BACKGROUND

The optimal perioperative management of biologic disease-modifying antirheumatic drugs (bDMARDs) in inflammatory rheumatic disease (IRD) patients undergoing total joint arthroplasty (TJA) remains debated, with current guidelines based on low-to-moderate quality evidence.

METHODS

Using the Taiwan National Health Insurance Research Database (NHIRD, 2004-2020), we identified IRD patients undergoing primary TJA and propensity score-matched them with non-IRD controls. Within the IRD cohort, patients were categorized by perioperative bDMARD strategy: continuation (n = 623) versus withholding (n = 631). Primary outcomes included surgical site infection (SSI), delayed wound healing, and disease flares within 30 days.

RESULTS

Among 1254 propensity-matched IRD patients, SSI rates were comparable between continuation and withholding groups, consistent with prior studies [12,17] (2.91%vs 2.51%; OR 1.31, p = 0.39), as was delayed wound healing (2.21%vs 1.09%; OR 2.02, p = 0.43). Disease flares were significantly lower with continuation (6.12%vs 22.33%; OR 0.13, p = 0.03). Healthcare costs were lower in the continuation group.

CONCLUSIONS

Perioperative bDMARD continuation was not associated with a significantly increased risk of SSI or wound complications but substantially reduced disease flares. Blanket bDMARD discontinuation may not be warranted, supporting individualized perioperative management.