George Michael D, Baker Joshua F, Hsu Jesse Yenchih, Wu Qufei, Xie Fenglong, Chen Lang, Yun Huifeng, Curtis Jeffrey R
University of Pennsylvania, Philadelphia.
University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia.
Arthritis Care Res (Hoboken). 2017 Dec;69(12):1845-1854. doi: 10.1002/acr.23209. Epub 2017 Nov 2.
The optimal timing of tumor necrosis factor antagonists before elective surgery is unknown. This study evaluated the association between infliximab timing and serious infection after elective hip or knee arthroplasty.
A retrospective cohort study evaluated US Medicare patients with rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis, or ankylosing spondylitis who received infliximab within 6 months of elective knee or hip arthroplasty from 2007 to 2013. Propensity-adjusted analyses examined whether infliximab stop timing (time between the most recent infusion and surgery) was associated with hospitalized infection within 30 days or prosthetic joint infection (PJI) within 1 year.
Hospitalized infection within 30 days occurred after 270 of 4,288 surgeries (6.3%). Infliximab stop timing <4 weeks versus 8-12 weeks was not associated with an increase in infection within 30 days (propensity-adjusted odds ratio [OR] 0.90 [95% confidence interval (95% CI) 0.60-1.34]). The rate of PJI was 2.9 per 100 person-years and was not increased in patients with stop timing <4 weeks versus 8-12 weeks (hazard ratio [HR] 0.98 [95% CI 0.52-1.87]). Glucocorticoid dosage >10 mg/day was associated with increased risk of 30-day infection (OR 2.11 [95% CI 1.30-3.40]) and PJI (HR 2.70 [95% CI 1.30-5.60]). Other risk factors for infection included elderly age, comorbidities, revision surgery, and previous hospitalized infection.
Administering infliximab within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short- or long-term serious infection compared to withholding infliximab for longer time periods. Glucocorticoid use, especially >10 mg/day, was associated with an increased infection risk.
肿瘤坏死因子拮抗剂在择期手术前的最佳使用时机尚不清楚。本研究评估了英夫利昔单抗使用时机与择期髋关节或膝关节置换术后严重感染之间的关联。
一项回顾性队列研究对2007年至2013年期间在择期膝关节或髋关节置换术6个月内接受英夫利昔单抗治疗的美国医疗保险患者进行了评估，这些患者患有类风湿性关节炎、炎症性肠病、银屑病、银屑病关节炎或强直性脊柱炎。倾向调整分析检查了英夫利昔单抗停药时机（最近一次输注与手术之间的时间）是否与30天内的住院感染或1年内的人工关节感染（PJI）有关。
4288例手术中有270例（6.3%）发生了30天内的住院感染。英夫利昔单抗停药时机<4周与8 - 12周相比，30天内感染未增加（倾向调整比值比[OR]0.90[95%置信区间(95%CI)0.60 - 1.34]）。PJI发生率为每100人年2.9例，停药时机<4周与8 - 12周的患者相比未增加（风险比[HR]0.98[95%CI0.52 - 1.87]）。糖皮质激素剂量>10mg/天与30天感染风险增加（OR 2.11[95%CI 1.30 - 3.40]）和PJI（HR 2.70[95%CI 1.30 - 5.60]）相关。其他感染风险因素包括老年、合并症、翻修手术和既往住院感染。
与更长时间停用英夫利昔单抗相比，在择期膝关节或髋关节置换术4周内使用英夫利昔单抗与短期或长期严重感染风险升高无关。使用糖皮质激素，尤其是剂量>10mg/天，与感染风险增加相关。
