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Perioperativer Umgang mit Biologika bei rheumatoider Arthritis

Perioperative use of biologicals in rheumatoid arthritis

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Zusammenfassung

Die Frage, ob bei Patienten mit rheumatoider Arthritis (RA) eine Biologika-Therapie mit TNF-α-Antagonisten vor einem elektiven orthopädischen Eingriff pausiert oder fortgeführt werden sollte, stellt angesichts der Häufigkeit einer immunsuppressiven Behandlung – nicht nur mit Biologika – und der Häufigkeit solcher operativen Eingriffe in dieser Population ein klinisch relevantes Problem dar. Die bisher zu dieser Frage durchgeführten wenigen, qualitativ nur begrenzt aussagefähigen Studien kommen zu uneinheitlichen Ergebnissen, sodass aus den vorhandenen Daten keine eindeutige generelle Empfehlung zu dieser Problematik abgeleitet werden kann. Daher erscheint eine individuell zugeschnittene Vorgehensweise auf der Grundlage einer fundierten Risikoabschätzung für postoperative Komplikationen für das Management der zu operierenden Patienten am besten geeignet.

Abstract

The high prevalence of patients with rheumatoid arthritis (RA) treated with biologics and the high proportion of RA patients requiring elective orthopaedic surgery indicates that the question of whether to continue or to interrupt biologic therapy in the context of a surgical procedure is a clinically relevant problem. Few data are available and the quality of the studies performed is somewhat limited. Thus, a straightforward recommendation on how this problem should be handled cannot be given on this basis. Therefore, individualized management based on risk stratification for postoperative complications seems currently to be the best solution.

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  1. Rheumazentrum Ruhrgebiet, Landgrafenstr. 15, 44652, Herne, Deutschland

    F. Heldmann, F. Dybowski, X. Baraliakos & J. Braun

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  1. F. Heldmann
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  2. F. Dybowski
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  3. X. Baraliakos
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  4. J. Braun
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Correspondence to F. Heldmann.

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Heldmann, F., Dybowski, F., Baraliakos, X. et al. Perioperativer Umgang mit Biologika bei rheumatoider Arthritis. Z. Rheumatol. 70, 14–20 (2011). https://doi.org/10.1007/s00393-010-0680-7

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  • DOI: https://doi.org/10.1007/s00393-010-0680-7

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