臨床整形外科54巻12号

2019年12月発行

誌上シンポジウム 患者の満足度を高める関節リウマチ手術

関節リウマチ周術期における薬物マネジメントのエビデンス

著者： 伊藤宣¹

所属機関： ¹京都大学医学部附属病院整形外科

ページ範囲：P.1241 - P.1245

　関節リウマチの周術期には，使用している抗リウマチ薬の適切なマネジメントが必要である．現在，多くないものの徐々にエビデンスが発表されており，それらをもとに各種のガイドラインが発表されている．原則的に，メトトレキサートは継続のまま手術に臨み，biological disease modifying anti-rheumatic drugsは，投与間隔分の休薬期間をもって手術を行うことが推奨されている．しかし，この原則にとらわれすぎることなく，個々の状況に応じて適切な対応をする必要がある．

参考文献

1) Yamanaka H, Tanaka E, Nakajima A, et al. A large observational cohort study of rheumatoid arthritis, IORRA:Providing context for today's treatment options. Mod Rheumatol 2019 Oct. 1:1-6. [Epub ahead of print]

2) Momohara S, Inoue E, Ikari K,et al. Recent trends in orthopedic surgery aiming to improve quality of life for those with rheumatoid arthritis:data from a large observational cohort. J Rheumatol 2014 May;41(5):862-6.

3) Momohara S, Yano K, Sakuma Y, et al. Recent Orthopedic Surgeries Aiming to Improve Quality of Life for Patients with Rheumatoid Arthritis. J Rheumatol 2016 Jan;43(1):245.

4) Goodman SM, Bykerk VP, DiCarlo E, et al. Flares in Patients with Rheumatoid Arthritis after Total Hip and Total Knee Arthroplasty:Rates, Characteristics, and Risk Factors. J Rheumatol 2018;45(5):604-11.

5) Murata K, Yasuda T, Ito H, et al. Lack of increase in postoperative complications with low-dose methotrexate therapy in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Mod Rheumatol 2006;16(1):14-9.

6) Global Guidelines for the Prevention of Surgical Site Infection. Geneva:World Health Organization;2018. WHO Guidelines Approved by the Guidelines Review Committee.

7) 日本リウマチ学会(編)．関節リウマチ診療ガイドライン2014．メディカルレビュー社：2014．

8) Salt E, Wiggins AT, Rayens MK, et al. Moderating effects of immunosuppressive medications and risk factors for post-operative joint infection following total joint arthroplasty in patients with rheumatoid arthritis or osteoarthritis. Semin Arthritis Rheum 2017;46(4):423-9.

9) Kubota A, Sekiguchi M, Nakamura T, et al. Does use of a biologic agent increase the incidence of postoperative infection in surgery for rheumatoid arthritis after total joint arthroplasty? Mod Rheumatol 2014;24(3):430-3.

10) Kadota Y, Nishida K, Hashizume K, et al. Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients. Mod Rheumatol 2016;26(1):68-74.

11) Suzuki M, Nishida K, Soen S, et al. Risk of postoperative complications in rheumatoid arthritis relevant to treatment with biologic agents:a report from the Committee on Arthritis of the Japanese Orthopaedic Association. J Orthop Sci 2011;16(6):778-84.

12) Ito H, Kojima M, Nishida K, et al. Postoperative complications in patients with rheumatoid arthritis using a biological agent-A systematic review and meta-analysis. Mod Rheumatol 2015;25(5):672-8.

13) Ito H, Tsuji S, Nakayama M, et al, Momohara S;JOSRA Consortium. Does abatacept increase postoperative adverse events in rheumatoid arthritis compared with conventional synthetic disease-modifying drugs? J Rheumatol 2019 Jun 15. [Epub ahead of print]

14) George MD, Baker JF, Winthrop K, et al. Risk of biologics and glucocorticoids in patients with rheumatoid arthritis undergoing arthroplasty:A cohort study. Ann Intern Med 2019;170(12):825-36.

15) Berthold E, Geborek P, Gülfe A. Continuation of TNF blockade in patients with inflammatory rheumatic disease. An observational study on surgical site infections in 1,596 elective orthopedic and hand surgery procedures. Acta Orthop. 2013;84(5):495-501.

16) George MD, Baker JF, Hsu JY, et al. Perioperative timing of infliximab and the risk of serious infection after elective hip and knee arthroplasty. Arthritis Care Res (Hoboken) 2017;69(12):1845-54.

17) George MD, Baker JF, Winthrop K, et al. Timing of abatacept before elective arthroplasty and risk of postoperative outcomes. Arthritis Care Res (Hoboken) 2019;71(9):1224-33.

18) Goodman SM, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. J Arthroplasty 2017;32(9):2628-38.