People with rheumatoid arthritis (RA) who take a disease-modifying antirheumatic drug (DMARD), such as methotrexate, or a biologic drug, such as etanercept (Enbrel) or adalimumab (Humira), may be able to stay on their medication before undergoing surgery without significantly increasing their risk of infection, according to a study presented at the American College of Rheumatology’s annual meeting this week in San Diego. 

The researchers however caution their results are preliminary. "I don't want to say from these results we can conclude that we want everyone to stop their medications – rather it is suggestive," says study co-author Bernard Ng, MD, chief of rheumatology at the VA Puget Sound Health Care System, in Seattle, Wash. "With finer analyses we can come up with  better recommendations."

Many surgeons have opinions on whether or not to take patients off these drugs before elective surgery, but there is no solid consensus on the best approach. The drugs work by suppressing the immune system, which is overactive in RA, and therefore they increase the risk of infection in general. In theory, this higher risk of infection could go up even more when a patient has surgery. But stopping an RA drug could increase the risk of a disease flare.

The results suggest "that it may not be necessary for RA patients to discontinue these medications prior to elective surgeries. Indeed, continuing these medications may reduce the risk of RA flares that may result from stopping them," notes Dr. Ng. But he points out that a deeper analysis of the data is necessary.

This study used a Veteran Affairs’ databases to compare infection risk in 6,548 RA patients treated between 2000 and 2009. It only looked at patients taking one medication (one DMARD or one biologic), not a combination of DMARDs or a biologic plus a DMARD. It compared post-surgical infections – including wound infections and general infections such as pneumonia and urinary tract infections – in patients who did and did not go off their RA medication.