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Discontinuation of all three medications 1 weeks prior to surgery
10%
246/2551
Discontinuation of sulfasalazine 1 weeks prior to surgery, continuation of etanercept and penicillamine
5%
127/2551
Continuation of sulfasalazine, penicillamine, and etanercept
128/2551
Continuation of sulfasalazine and penicillamine, discontinuation of etanercept 1 week prior to surgery
65%
1651/2551
Continuation of penicillamine, discontinuation of sulfasalazine and etanercept 1 week prior to surgery
15%
386/2551
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Anticytokine disease-modifying antirheumatic drugs (DMARD) have become increasingly popular in the treatment of RA. Immunosuppression and the risk of infection are potential complications for all anti-TNF-alpha medications. Current recommendations for cessation of immunosuppressive therapy are when the drug concentrations are at their lowest levels which include the following: 3 days after etanercept injection; 2 weeks prior to infliximab infusion; 10 days after adalimumab injection. Medications such as sulfasalazine and penicillamine may be continued during the pre and post-operative period. Recent evidence and guidelines such as those reviewed by Keith's paper, suggest that anti-TNF-alpha medications should be stopped 4 weeks prior to surgery. Giles et al report in their case control series an increased infection rate of RA patients undergoing an orthopaedic procedure who were on TNF-a inhibitors as opposed to patients on more traditional treatment regimens like methotrexate and prednisone.
2.5
(41)
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