Krüger K, Albrecht K, Rehart S, Scholz R
Niedergelassener Rheumatologe, Praxiszentrum, Sankt-Bonifatius, 81541, München, Deutschland,
Z Rheumatol. 2014 Feb;73(1):77-84. doi: 10.1007/s00393-013-1301-z.
The perioperative administration of antirheumatic medication can lead to an increased risk of infection and to a malfunction in wound healing up to a manifest infection; however, the termination of antirheumatic therapy can result in a flare up of the disease. Both situations can endanger the success of the operation, particularly in arthroplasty.
The recommendations have been developed and approved by the Pharmacotherapy Commission of the German Society for Rheumatology following a systematic literature search (as of 30 April 2013) and a consensus process.
As very little data with sufficiently high evidence are available, the present recommendations should be considered as having an advisory quality and an individual risk assessment should always be carried out. Classical disease-modifying antirheumatic drugs (DMARD), such as methotrexate can be continued in normal cases but whether this is also true for leflunomide is still undecided. For biologicals a break of two half-life periods before the operation is recommended. The therapy can be continued after wound healing has been completed and when there are no signs of infection.
围手术期使用抗风湿药物会增加感染风险，并可能导致伤口愈合不良直至出现明显感染；然而，终止抗风湿治疗可能会引发疾病复发。这两种情况都可能危及手术的成功，尤其是在关节置换术中。
这些建议是德国风湿病学会药物治疗委员会在系统文献检索（截至2013年4月30日）和共识过程后制定并批准的。
由于可获得的具有足够高证据水平的数据非常少，目前的建议应被视为具有咨询性质，并且应始终进行个体风险评估。在正常情况下，经典的改善病情抗风湿药物（DMARD），如甲氨蝶呤可以继续使用，但来氟米特是否也如此仍未确定。对于生物制剂，建议在手术前中断两个半衰期。在伤口愈合完成且无感染迹象时，可以继续治疗。
