Analysis of C-reactive protein levels and febrile tendency after joint surgery in rheumatoid arthritis patients treated with a perioperative 4-week interruption of tocilizumab

Excerpt

Tocilizumab is a humanized anti-human IL-6 receptor monoclonal antibody that has been demonstrated to improve rheumatoid arthritis (RA) symptoms [1‐5]. However, it remains unclear whether the use of biological agents, including tocilizumab, constitutes an independent risk factor for postoperative surgical site infection (SSI). Some reports of joint surgeries in RA patients treated with tumor necrosis factor (TNF) alpha blockers have demonstrated no increase in the incidence of postoperative infection [6, 7]. In contrast, other reports have suggested higher complication rates with TNF blockers [8, 9]. We also reported that the use of TNF blockers was a likely cause of SSI [10], although we diagnosed SSI using the criteria for defining SSI in the Guideline for Prevention of Surgical Site Infection, 1999 [11]. These conflicting data make the effects of TNF blocker therapy on the risk of postoperative infection during orthopedic intervention unclear. Meanwhile, the perioperative mechanisms of tocilizumab are also currently under investigation. Unfortunately, only one study of the clinical features of tocilizumab-treated RA patients following joint surgery has been published [12]. Therefore, more data are required to fully evaluate the influence of tocilizumab on postoperative complications. …