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Arthritis and Rheumatism

Is it Safe to Take RA Medicines Before Surgery?

11/14/2007

Question:

I am taking Enbrel, Prednisone, MTX and Arthrotec for my RA. Do I have to stop taking any of these medications if I was to get a D & C done?

Answer:

There is a lot of controversy on whether or not TNF-alpha blockade medicines, such as etanercept (Enbrel), should be temporarily stopped in the perioperative period (the window of time before, during, and after a surgery). The concerns are that continued use of TNF-blockade medicines perioperatively may increase the risk of infection or delay wound healing. However, there is no definitive evidence that increased infection or delayed wound healing actually occurs if the medicines are continued. The same discussion holds true for methotrexate.

If the decision is made to stop etanercept or methotrexate prior to surgery, your clinician may base it upon the type of surgery to be performed. For instance, if the surgery is one that is performed on a body part that is sterile, such as a joint replacement surgery, your clinician may either opt to not stop the medicines or may opt to stop the medicine about 1-2 weeks prior to the surgery. If the surgery is one that is performed on a body part that is not sterile, such as a colon surgery, your clinician may opt to stop the medicine 3-4 weeks prior to the surgery.

The problem with not taking your etanercept before and after the surgery, is the risk of a flare of your rheumatoid arthritis (RA). If a flare occurs and needs to be treated with a burst of your corticosteroid (ie, Prednisone), this may increase your risk of infection or poor wound healing as well.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University