Berber O, Berber R, Back D L, Sandiford N A
Department of Orthopaedics and Trauma, Guys and St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom.
Curr Rheumatol Rev. 2018 Apr 20;14(1):46-52. doi: 10.2174/1573397112666161128094138.
Biologic agents have contributed significantly to the management of patients with in rheumatoid arthritis (RA). A significant proportion of patients with RA still require arthroplasty procedures however. It is unclear whether these agents increase the risk of post operative infection after lower limb arthroplasty.
A literature search was performed for articles published over the last 10 years in the English language examining the association between anti-tumour necrosis factor inhibitors and the incidence of post operative infection in patients with RA undergoing hip and knee arthroplasty procedures.
One large meta-analysis has been published suggesting a 2-fold increase in infection rates following orthopaedic surgery in patients receiving biological agents. When subgroup analysis of arthroplasty cases alone was performed the finding failed to reach significance. However, several further studies have demonstrated both an increased risk for surgical site infection with the use of biological agents and several conflicting articles argue the opposite.
There is no current consensus on this topic. The safety of continuation of perioperative anti-TNF-α therapy in patients undergoing lower limb arthroplasty procedures is unclear. There is also little robust guidance from specialist rheumatologic societies. There is need for large scale multicentre randomised controlled trials to address this issue.
生物制剂对类风湿关节炎（RA）患者的治疗有显著贡献。然而，相当一部分RA患者仍需要进行关节置换手术。目前尚不清楚这些药物是否会增加下肢关节置换术后的感染风险。
对过去10年发表的英文文章进行文献检索，研究抗肿瘤坏死因子抑制剂与接受髋关节和膝关节置换手术的RA患者术后感染发生率之间的关联。
一项大型荟萃分析表明，接受生物制剂治疗的患者骨科手术后感染率增加了两倍。仅对关节置换病例进行亚组分析时，该发现未达到显著水平。然而，其他几项研究表明，使用生物制剂会增加手术部位感染的风险，也有几篇相互矛盾的文章持相反观点。
目前关于这个话题没有共识。下肢关节置换手术患者围手术期继续使用抗TNF-α治疗的安全性尚不清楚。专科风湿病学会也几乎没有强有力的指导意见。需要开展大规模多中心随机对照试验来解决这个问题。
