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International Journal of Rheumatology
Volume 2012, Article ID 369565, 5 pages
Review Article

Risk of Orthopedic Surgical Site Infections in Patients with Rheumatoid Arthritis Treated with Antitumor Necrosis Factor Alfa Therapy

1Department of Internal Medicine, Hospital SARAH Brasília, SARAH Network of Rehabilitation Hospitals, SMHS Quadra 301 Bloco A, 70.335-901 Brasília-DF, Brazil
2Department of Rheumatology, University of Brasília, SGAN 605, Av. L2 Norte, 70840-901 Brasília-DF, Brazil
3Department of Internal Medicine, University of Brasília, SGAN 605, Av. L2 Norte, 70840-901 Brasília-DF, Brazil

Received 27 October 2011; Accepted 15 December 2011

Academic Editor: Yehuda Shoenfeld

Copyright © 2012 Bernardo Matos da Cunha 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.


Introduction. International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation. Objectives. To study literature evidence assessing the risk of surgical site infections in orthopedic surgery patients with RA using anti-TNF drugs, compared to untreated patients or those using conventional DMARD. Methods. Systematic review of cohort studies is concerning surgical site infections in orthopedic procedures in patients with RA. Results. Three studies were selected. Only one was considered of high-quality, albeit with low statistical power. The review resulted in inconclusive data, since the best quality study showed no significant differences between groups, while others showed increased risk of infections in patients using anti-TNF medications. Conclusion. It is unclear whether patients with RA using anti-TNF medications are at increased risk of surgical site infections. Randomized controlled trials or new high quality observational studies are needed to clarify the issue.