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ISRN Rheumatology
Volume 2012 (2012), Article ID 251962, 5 pages
http://dx.doi.org/10.5402/2012/251962
Clinical Study

Wound Healing with Medications for Rheumatoid Arthritis in Hand Surgery

1Pulvertaft Hand Centre, Kings Treatment Centre, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK
2Department of Rheumatology, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK
3A. Alfred Taubman Health Care Center, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
4Curtis National Hand Center, Union Memorial Hospital, Johnston Professional Building, 2nd Floor, 3333 North Calvert Street, Baltimore, MD 21218 , USA

Received 30 September 2012; Accepted 4 November 2012

Academic Editors: A. Spreafico, P. Voulgari, and A. H. Wanivenhaus

Copyright © 2012 A. R. Barnard et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Medications used to treat rheumatoid arthritis, such as corticosteroids, disease-modifying agents (DMARDs), and injectable biological agents (anti-TNFα), may have widespread effects on wound healing. In hand surgery, it is important to balance the risks of poor wound healing from continuing a medication against the risks of a flare of rheumatoid arthritis if a drug is temporarily discontinued. Materials and Methods. A United Kingdom (UK) group of 28 patients had metacarpophalangeal joint replacement surgery in 35 hands (140 wounds). All medication for rheumatoid arthritis was continued perioperatively, except for the injectable biological agents. Results. There were no instances of wound dehiscence or deep infection and only one episode of minor superficial infection. Conclusions. We conclude that provided care is taken to identify and treat any problems promptly, it is appropriate to continue most antirheumatoid medications in the perioperative period during hand surgery to reduce the risk of destabilising the patients' overall rheumatoid disease control.