Del Olmo L, Hernández B, Galindo-Izquierdo M, Tébar D, Balsa A, Carmona L
Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.
Rev Esp Cir Ortop Traumatol. 2012 Sep-Oct;56(5):393-412. doi: 10.1016/j.recot.2012.05.001. Epub 2012 Jun 28.
The objective of this paper is make recommendations for the perioperative management of antirheumatic treatment based on the best available evidence. A systematic review was performed including studies in which patients with rheumatic diseases treated with biological and non-biological disease-modifying antirheumatic drugs (DMARDs) had undergone surgery. A total of 5,285 studies were recorded, of which 27 were finally included. These contained information on 5,268 patients and 7,933 surgeries. The majority were women (mean age 55 years) were diagnosed with rheumatoid arthritis, and the most studied drug was methotrexate (MTX). The final recommendations include: maintaining treatment with MTX or leflunomide in the perioperative period in the absence of other risk factors for postoperative complications (Level of Evidence 1c, Grade D recommendation). Biological DMARDs should be temporarily suspended, or the surgery scheduled as far as possible from the last dose, and, if there were other risk factors a space at least two doses (Level of Evidence 2c; Grade D recommendation).
本文的目的是基于现有最佳证据，对抗风湿治疗的围手术期管理提出建议。进行了一项系统综述，纳入了使用生物和非生物改善病情抗风湿药物（DMARDs）治疗的风湿性疾病患者接受手术的研究。共记录了5285项研究，最终纳入27项。这些研究包含了5268例患者和7933例手术的信息。大多数患者为女性（平均年龄55岁），诊断为类风湿关节炎，研究最多的药物是甲氨蝶呤（MTX）。最终建议包括：在没有其他术后并发症风险因素的情况下，围手术期维持MTX或来氟米特治疗（证据级别1c，D级推荐）。生物DMARDs应暂时停用，或将手术尽可能安排在距最后一剂较远的时间，如果存在其他风险因素，则间隔至少两剂（证据级别2c；D级推荐）。
