Table 4. Summary of Recommendations (all are conditional)
(Level of evidence in parentheses)
RA, SpA
including
AS and
PsA JIA
SLE
a
Nonbiologic
DMARDs SLE
Severe
SLE
Continue the current dose of
methotrexate, leflunomide,
hydroxychloroquine, and/or
sulfasalazine (nonbiologic DMARDs)
for patients undergoing elective THA
or TKA. (Low-Moderate)
✓ ✓ ✓
Withhold all current biologic agents
prior to surgery in patients undergoing
elective THA or TKA, and plan the
surgery at the end of the dosing cycle
for that specific medication. (Low)
✓ ✓ ✓
Withhold tofacitinib for at least 3 days
prior to surgery in patients undergoing
THA or TKA. (Low)
✓ ✓
Continue the current dose of
mycophenolate mofetil, azathioprine,
cyclosporine, or tacrolimus through
the surgical period in all patients
undergoing THA or TKA. (Low)
✓
Withhold the current dose of
mycophenolate mofetil, azathioprine,
cyclosporine, or tacrolimus 1 week
prior to surgery in all patients
undergoing THA or TKA. (Low)
✓
Restart biologic therapy in patients
for whom biologic therapy was
withheld prior to undergoing THA
or TKA once the wound shows
evidence of healing (typically ~14
days), all sutures/staples are out,
there is no significant swelling,
erythema, or drainage, and there is
no clinical evidence of non–surgical
site infections, rather than shorter or
longer periods of withholding. (Low)
✓ ✓ ✓
Continue the current daily dose of
glucocorticoids in adult patients
who are receiving glucocorticoids
for their rheumatic condition and
undergoing THA or TKA, rather
than administering perioperative
supra-physiologic glucocorticoid doses
(so-called "stress dosing"). (Low)
✓ ✓
a
See Table 3.
