Albrecht Katinka, Leipe Jan
Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Mannheim, Mannheim, Deutschland.
Z Rheumatol. 2022 Aug;81(6):492-500. doi: 10.1007/s00393-022-01236-y. Epub 2022 Jul 8.
In patients with inflammatory rheumatic diseases, a decision is needed prior to elective surgery on whether the medicinal treatment can be continued or whether the dose needs to be changed or interrupted. The German Society for Rheumatology (DGRh) has developed updated recommendations that specify a course of action for disease-modifying antirheumatic drugs (DMARD) and glucocorticoids. The recommendations for action can be adapted to the individual situation and coordinated with the interdisciplinary treating physicians and the patient. Depending on the dose, glucocorticoids have a high risk of infection and should be set as low as possible in the preoperative period. Most of the conventional synthetic (cs)DMARDs can be continued. Under biologic (b)DMARDs treatment surgery can be scheduled for the end of each treatment interval. It is recommended that Janus kinase (JAK) inhibitors should be interrupted for 3-4 days before major interventions. Treatment should be restarted as soon as possible, depending on the wound healing.
对于患有炎性风湿性疾病的患者，在择期手术前需要决定是否可以继续药物治疗，或者是否需要改变剂量或中断治疗。德国风湿病学会（DGRh）制定了最新建议，明确了改善病情抗风湿药（DMARD）和糖皮质激素的行动方案。这些行动建议可根据个体情况进行调整，并与跨学科治疗医生和患者进行协调。根据剂量不同，糖皮质激素有较高的感染风险，在术前应尽可能降低剂量。大多数传统合成（cs）DMARDs可以继续使用。在生物（b）DMARDs治疗期间，手术可安排在每个治疗间隔结束时进行。建议在进行重大干预前3 - 4天停用Janus激酶（JAK）抑制剂。根据伤口愈合情况，应尽快重新开始治疗。
