What is Rheumatoid Arthritis? Do DMARD’s increase infection risk in F&A surgery?

Description

This VTT document captures a presentation delivered by Dr. Alan MacDonald, who discusses the complexities surrounding the treatment of rheumatoid arthritis (RA) and the implications of disease-modifying antirheumatic drugs (DMARDs) on surgery and infection risk. The talk begins with a warm welcome and a brief overview of Dr. MacDonald's professional background and disclosures.



He emphasizes the improved outcomes for patients with RA but notes that there remain concerns about patients with long-term disease who may still require surgical intervention. Dr. MacDonald seeks to answer the pressing question of whether DMARDs increase infection risk, particularly in the context of surgery. He acknowledges the challenge of this question and elaborates on the different classes of DMARDs in use, including traditional options like methotrexate and newer biologics.



The presentation reveals that while modern biologics can increase infection risk, the actual risks during surgery are less clear, leading to evolving guidelines about whether to continue or stop medications prior to surgical procedures. According to a groundbreaking study presented, continuing methotrexate during surgery resulted in significantly lower infection rates compared to patients who paused their treatment. This finding led to changes in clinical practice guidelines, emphasizing the retention of methotrexate during surgical interventions.



Dr. MacDonald discusses current guidelines, advocating for the continuation of methotrexate and leflunomide, while also advising against the use of biologic DMARDs during surgery. He shares insights regarding the implications of patient management and medication adherence, suggesting that better clinical outcomes are aligned with well-controlled disease states rather than merely focusing on medication types.



In conclusion, he highlights the importance of recognizing individual patient factors over medication concerns when assessing risks associated with surgery. The talk wraps up with thanks and a note on the ongoing need to address drug safety and patient characteristics in the ever-evolving landscape of medical treatment.

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