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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
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BMC Rheumatology

ISSN: 2520-1026

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