Resuming Biologic Therapy After Orthopedic Surgery
Rationale for Timing of Biologic Restart
- The American College of Rheumatology recommends restarting biologic therapy like Enbrel (etanercept) after orthopedic surgery once the surgical wound shows evidence of healing, all sutures/staples are out, there is no significant swelling, erythema, or drainage, and there is no clinical evidence of non-surgical site infections, which typically occurs around 14 days after surgery 1, 2, 3
- The decision to restart biologic therapy should be based on careful evaluation of wound healing status, absence of sutures/staples, resolution of significant swelling, erythema, or drainage, and no clinical evidence of surgical or non-surgical site infections 2, 4, 3
Clinical Considerations
- A history of prior severe infections may warrant longer withholding periods of biologic therapy, according to the American College of Rheumatology 1, 3
- The American College of Rheumatology suggests that a history of prosthetic joint infections may require extended medication withholding 1, 3
- Disease flares may occur if biologic therapy is withheld for extended periods, highlighting the importance of timely restart 2, 3
Glucocorticoid Management
- The American College of Rheumatology recommends continuing the current daily dose of glucocorticoids rather than administering supraphysiologic "stress doses" for patients on glucocorticoids for rheumatoid arthritis 1, 2, 3
- This recommendation applies to patients receiving ≤16 mg/day prednisone or equivalent, as stated by the American College of Rheumatology 7, 5