Sreekumar Ramankutty, Gray Julie, Kay Peter, Grennan David Michael
Wrightington Hospital Wigan, United Kingdom.
Acta Orthop Belg. 2011 Dec;77(6):823-6.
In the 1990's there were concerns that methotrexate might increase the risk of post operative complications following elective orthopaedic surgery; as a result many Units initiated policies to discontinue methotrexate prior to elective orthopaedic surgery. In 2001 we carried out a controlled study of complications after elective surgery in rheumatoid arthritis (RA) patients who either continued or discontinued methotrexate prior to surgery. In this study we showed that continuation of methotrexate therapy prior to orthopaedic surgery did not increase the risk of infection or surgical complication occurring in patients with RA within one year of surgery. The limitation of this study was that complications later than one year were not studied. Sixty-five patients have been followed up. Thirty-one were fully assessed in clinic and 34 underwent a structured telephone interview. There were no incidences of deep bone infection in any patient group so that there is no evidence that continued methotrexate therapy in the perioperative period increases the risk of late deep infections. We adhere to our original advice that in the absence of renal failure or sepsis, methotrexate therapy should not be stopped before elective orthopaedic surgery in patients with RA whose disease is controlled by the drug before surgery.
在20世纪90年代，人们担心甲氨蝶呤可能会增加择期骨科手术后的术后并发症风险；因此，许多科室制定了在择期骨科手术前停用甲氨蝶呤的政策。2001年，我们对类风湿关节炎（RA）患者进行了一项对照研究，这些患者在手术前继续或停用了甲氨蝶呤。在这项研究中，我们表明，骨科手术前继续使用甲氨蝶呤治疗不会增加RA患者在手术后一年内发生感染或手术并发症的风险。这项研究的局限性在于没有研究一年后的并发症。65名患者得到了随访。31名患者在诊所进行了全面评估，34名患者接受了结构化电话访谈。任何患者组均未发生深部骨感染，因此没有证据表明围手术期继续使用甲氨蝶呤治疗会增加晚期深部感染的风险。我们坚持我们原来的建议，即在没有肾衰竭或脓毒症的情况下，对于术前疾病由该药物控制的RA患者，在择期骨科手术前不应停止甲氨蝶呤治疗。
