Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery
Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery
复制标题
DOI：
10.1136/ard.60.3.214
复制
发表时间：
2001-03-01
影响因子：
27.4
通讯作者：
Fear, S
中科院分区：
文献类型：
--
作者：
Grennan, DM;Gray, J;Fear, S
目的-确定持续甲氨蝶呤治疗是否增加类风湿关节炎（RA）患者在择期骨科手术后一年内术后感染或手术并发症的风险。设计-一项前瞻性随机研究，研究接受择期骨科手术的RA患者在手术后一年内发生的术后感染或手术并发症。受试者-388例接受择期骨科手术的RA患者。接受甲氨蝶呤治疗的患者被随机分配到继续甲氨蝶呤治疗组（A组）或从术前2周至术后2周停用甲氨蝶呤治疗组（B组）。将其并发症发生率与228例未接受甲氨蝶呤治疗并接受择期骨科手术的RA患者（C组）的并发症发生率进行比较。和伤口裂开的频率，以及在一个月内发生的需要二次翻修手术的任何手术并发症的发生率。手术年。记录术后6周和6个月RA发作频率。类风湿性疾病的发作被定义为患者告知的两个或多个关节的关节疼痛增加以及手术后关节指数增加至少25%。结果-A组88例手术中有2例（2%）发生感染或手术并发症的迹象，B组72例手术中有11例（15%），C组228例中24例（10.5%）。A组手术并发症及感染发生率均低于B组（p
Objectives-To determine whether continued methotrexate treatment increases the risk of postoperative infections or of surgical complications in patients with rheumatoid arthritis (RA) within one year of elective orthopaedic surgery.Design-A prospective randomised study of postoperative infection or surgical complications occurring within one year of surgery in patients with RA who underwent elective orthopaedic surgery.Subjects-388 patients with RA who were to undergo elective orthopaedic surgery. Patients who were receiving methotrexate were randomly allocated to groups who either continued methotrexate (group A) or who discontinued methotrexate from two weeks before surgery until two weeks after surgery (group B). Their complication rates were compared with complications occurring in 228 patients with RA (group C) who were not receiving methotrexate and who also underwent elective orthopaedic surgery.Main outcome measures-Signs of postoperative infection were recorded, including rubor, discharge, systemic infection, and frequency of wound dehiscence as well as the incidence of any surgical complication requiring a secondary revision procedure that occurred within one year of surgery. The frequencies of flare up activity of RA at six weeks and six months after surgery were also recorded. A flare of rheumatoid disease was defined as an increase in joint pain in two or more joints notified by the patient as well as by an increase in articular index of at least 25% after surgery.Results-Signs of infection or surgical complications occurred in two of 88 procedures in group A (2%), 11 of 72 procedures in group B (15%), and 24 of 228 (10.5%) procedures in group C. The surgical complication or infection frequency in group A was less than that in either group B (p