Holding DMARDs/rheumatology meds before permanent stim implant

[seamonkey]

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I've managed to avoid this situation until now, but I have a patient is out of other options and as a long shot we did a stimulator trial, which I actually thought was not going to work - but it actually worked very well for him.

He's on methotrexate, cimzia, and arava for RA and Crohns

I am concerned about his increased risk of postoperative infection and wondering what other people do in these situations.
I understand that the very least I can talk to his rheumatologist about holding the meds for awhile, but I am wondering if anybody else shares my concerns? If so what do you typically do?

 

[buddababa]

Last time this happened to me, i made them hold it for a week (at least the methotrexate) that’s all they were on, have to balance flare up vs infection,

 

[Timeoutofmind]

Follow ACR guidelines for joint replacement is what I do.

 

[Orin]

2022 update has a nice table.

2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty -

This updated guideline includes recently introduced immunosuppressive medications to help decision-making by clinicians and patients regarding perioperative disease-modifying medication management for patients with IA and SLE at the time of elective THA or TKA.

pubmed.ncbi.nlm.nih.gov

 

[interjectionreflection]

To piggyback off this has anyone been holding these for epidurals, root block, joint or facet procedures? No one in my group including myself do not but curious if that's the practice for everyone when you're doing single shot vs implant

 

[nvrsumr]

No. Document discussed increased infection risk

 

[seamonkey]

Thanks for the suggestions and advice. I got in touch with the rheumatologist and they have a whole protocol they follow for implants like stimulators and pacers/ICDs etc.

 

[paindoc503]

To piggyback off this has anyone been holding these for epidurals, root block, joint or facet procedures? No one in my group including myself do not but curious if that's the practice for everyone when you're doing single shot vs implant

I'd be curious to hear what other people are doing too. I've never held any immunosuppressants for these procedures, but I have heard of some docs asking for rheum clearance