Biologic DMARD therapy with TNF-alpha inhibitors (e.g., etanercept) in rheumatoid arthritis patients undergoing elective total joint replacement should be:

• A Withheld for one dosing cycle before surgery and resumed after wound healing (at least 2 weeks postoperative) ✓
• B Continued without interruption throughout the perioperative period
• C Permanently discontinued once surgery is planned
• D Switched to oral methotrexate 2 weeks before surgery

Explanation

ACR/AAHKS (2017, updated 2022) guidelines recommend withholding biologic DMARDs (TNF inhibitors, IL-6 inhibitors, abatacept) for one dosing interval before elective orthopedic surgery to reduce the risk of surgical site infection, as these agents impair immune surveillance. Methotrexate and hydroxychloroquine can be continued. Biologics are typically resumed 2-4 weeks postoperatively once the wound has healed and there are no signs of infection. Continuing biologics perioperatively approximately doubles the risk of periprosthetic joint infection.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.