Systemic inflammatory responses after orthopedic surgery in patients with rheumatoid arthritis treated with tofacitinib
Systemic inflammatory responses after orthopedic surgery in patients with rheumatoid arthritis treated with tofacitinib
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托法替布治疗类风湿关节炎患者骨科手术后的全身炎症反应
DOI：
10.1007/s10067-021-05914-1
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发表时间：
2021
影响因子：
3.4
通讯作者：
Tanaka Sakae
中科院分区：
文献类型：
--
作者：
Uchio Akihiro;Matsumoto Takumi;Maenohara Yuji;Omata Yasunori;Takahashi Hiroshi;Iwasawa Mitsuyasu;Juji Takuo;Nakamura Ichiro;Tanaka Sakae
目的探讨Janus激酶（JAK）抑制剂托法替尼（tofacitinib）治疗类风湿关节炎（RA）患者对手术应激的急性期反应。患者的年龄、性别和手术类型相匹配;骨科手术后2周内，比较托法替尼组和csDMARDs组的体温、C反应蛋白（CRP）水平、白色血细胞（WBC）计数、中性粒细胞计数和淋巴细胞计数。术后并发症在90天内也assessed.ResultsNo手术部位感染或伤口愈合延迟观察托法替尼组，而，1例浅表感染中注意到csDMARDs组。在两组中观察到相似的术后体温和CRP水平升高。术后，托法替尼组显示WBC和中性粒细胞计数增加，淋巴细胞计数减少，与csDMARDs组不同。与csDMARDs组2例（2.6%）相比，托法替尼组7例（20.6%）术后2周内淋巴细胞计数低于500 cells/μL.ConclusionTofacitinib不能抑制术后体温和CRP水平的升高。由于接受托法替尼治疗的患者术后淋巴细胞计数降低，关键点·本研究首次报告了骨科手术后接受托法替尼治疗的患者的并发症和全身炎症反应，并与接受常规合成疾病缓解抗风湿药物治疗的患者进行了比较。（csDMARDs）·虽然托法替尼不能抑制术后体温和CRP水平的升高，但与接受csDMARDs治疗的患者相比，接受托法替尼治疗的患者术后淋巴细胞计数显著降低·术后恢复托法替尼治疗时应注意淋巴细胞计数降低
ObjectiveTo investigate the acute phase response to surgical stress in patients with rheumatoid arthritis (RA) treated with tofacitinib, a Janus kinase (JAK) inhibitor.MethodsA retrospective matched pair analysis of 34 patients treated with tofacitinib and 34 patients treated with conventional disease-modifying anti-rheumatic drugs (csDMARDs) was performed. Patients were matched for age, sex, and type of surgery; body temperature, C-reactive protein (CRP) level, and white blood cell (WBC) count, neutrophil count, and lymphocyte count were compared between the tofacitinib and csDMARDs groups within 2 weeks after orthopedic surgery. Postoperative complications within 90 days were also assessed.ResultsNo surgical site infection or delayed wound healing was observed in the tofacitinib group; whereas, one case of superficial infection was noted in the csDMARDs group. A similar postoperative increase in body temperature and CRP level was observed in both the groups. Postoperatively, the tofacitinib group showed an increase in WBC and neutrophils counts and a decrease in lymphocyte count, unlike the csDMARDs group. In contrast to two patients (2.6%) in the csDMARDs group, seven patients (20.6%) in the tofacitinib group had lymphocyte counts below 500 cells/μL within 2 weeks postoperatively.ConclusionTofacitinib did not suppress postoperative increase in body temperature and CRP level. Because of the postoperative decrease in lymphocyte count in patients treated with tofacitinib, the timing for resuming tofacitinib treatment after surgery should be carefully considered.Key Points• This study is the first to report the complications and systemic inflammatory responses after orthopedic surgery in patients treated with tofacitinib in comparison with matched pairs treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs)• While tofacitinib does not suppress postoperative increase in body temperature and CRP level, the postoperative decrease in lymphocyte count in patients treated with tofacitinib is significant compared with patients treated with csDMARDs• Attention should be paid to a reduced lymphocyte count when to resume tofacitinib after surgery
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DOI：
10.1002/art.39996
发表时间：
2017-04
期刊：
Arthritis & rheumatology (Hoboken, N.J.)
影响因子：
--
作者：
Smolen JS;Aletaha D;Gruben D;Zwillich SH;Krishnaswami S;Mebus C
通讯作者：
Mebus C
影响因子：
13.3
作者：
van Vollenhoven, Ronald;Lee, Eun Bong;Choy, Ernest
通讯作者：
Choy, Ernest
影响因子：
2.2
作者：
Nishida, Keiichiro;Harada, Ryozo;Ozaki, Toshifumi
通讯作者：
Ozaki, Toshifumi
影响因子：
0.9
作者：
Bari, Syed Farhan;Khan, Afsha;Lawson, Tom
通讯作者：
Lawson, Tom