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Table 1 Medicatons included in this guidelinea

From: Perioperative medical management for patients with RA, SPA, and SLE undergoing total hip and total knee replacement: a narrative review

DMARDs: CONTINUE these medications through surgery.

Dosing Interval

Continue/Withhold

Methotrexate

Weekly

Continue

Sulfasalazine

Once or twice daily

Continue

Hydroxychloroquine

Once or twice daily

Continue

Leflunomide (Arava)

Daily

Continue

Doxycycline

Daily

Continue

BIOLOGICS: STOP these medications prior to surgery and schedule surgery at the end of the dosing cycle. RESUME medications at minimum 14 days after surgery in the absence wound healing problems, surgical site infection or systemic infection.

Dosing Interval

Schedule Surgery (relative to last biologic dose administered)

Adalimumab (Humira) 40 mg

Every 2 weeks

Week 3

Etanercept (Enbrel) 50 mg or 25 mg

Weekly or twice weekly

Week 2

Golimumab (Simponi)50 mg

Every 4 weeks (SQ)or

Week 5

 

Every 8 weeks (IV)

Week 9

Infliximab (Remicade)3 mg/kg

Every 4, 6, or 8 weeks

Week 5, 7, or 9

Abatacept (Orencia) weight-based 500 mg; IV 1000 mg; SQ

Monthly (IV)or

Week 5

125 mg

Weekly (SQ)

Week 2

Rituximab (Rituxan)1000 mg

2 doses 2 weeks apart every 4–6 months

Month 7

Tocilizumab (Actemra) IV 4 mg/kg;

Every week (SQ) or Every 4 weeks

Week 3

SQ 162 mg

(IV)

Week 5

Anakinra (Kineret) SQ 100 mg

Daily

Day 2

Secukinumab (Cosentyx) 150 mg

Every 4 weeks

Week 5

Ustekinumab (Stela) 45 mg

Every 12 weeks

Week 13

Belimumab (Benlysta) 10 mg/kg

Every 4 weeks

Week 5

Tofacitinib (Xeljanz) 5 mg: STOP this medication 7 days prior to surgery.

Daily or twice daily

7 days after last dose

SEVERE SLE-SPECIFIC MEDICATIONS: CONTINUE these medications in the perioperative period.

Dosing Interval

Continue/Withhold

Mycophenolate

Twice daily

Continue

Azathioprine

Daily or twice daily

Continue

Cyclosporine

Twice daily

Continue

Tacrolimus

Twice daily (IV and PO)

Continue

NOT-SEVERE SLE: DISCONTINUE these medications in the perioperative period.

Dosing Interval

Continue/Withhold

Mycophenolate

Twice daily

Withhold

Azathioprine

Daily or twice daily

Withhold

Cyclosporine

Twice daily

Withhold

Tacrolimus

Twice daily (IV and PO)

Continue

  1. Dosing intervals obtained from prescribing information provided online by pharmaceutical companies
  2. a2016 American College of Rheumatology/American Association of Hip and Knee Surgeons Guidelines for the Perioperative Management of Anti-rheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Permission to reuse given by John Wiley and Sons on August 28, 2017, License Number 4177680712679