6533b826fe1ef96bd1283f17

RESEARCH PRODUCT

Surgery during etanercept therapy in patients with rheumatoid arthritis: is it time to follow patient preferences?

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Tumor necrosis factor (TNF)-a inhibitors, such as etanercept and infliximab, improve symptoms and function in patients affected by rheumatoid arthritis (RA) [1, 2] and, therefore, are playing an increasing role in the management of this disease. However, interference with endogenous TNF-a signalling has been reported to alter both normal inflammatory responses in tissue healing and infection surveillance [2, 3]. To our knowledge, the rates of surgery in RA are decreasing. However, with the duration of antiTNF therapy, the number of patients under these agents having surgery will be increasing. These data raise the question of whether TNF-inhibitors can be safely used in RA patients who should undergo surgery. The aim of the present paper was to discuss the effect of TNF-inhibitor use in RA patients undergoing surgery. A small cohort of patients undergoing different elective surgery while still on etanercept therapy in spite of physician advice was evaluated. Here, we report five cases selected from a large cohort of patients referred to the ‘‘Civico e Benfratelli’’ rheumatologic outpatient clinic (Table 1). The median duration of RA in the whole cohort was 10 years (range 1–23 years). The inclusion criterion was a history of elective surgery during etanercept therapy (25 mg twice weekly) started at least 12 months before surgery. All the assessed patients were on methotrexate (10–20 mg weekly) as diseasemodifying anti-rheumatic drug (DMARD) treatment and non-steroidal anti-inflammatory drugs or low-dose steroids for acute or sub-acute pain treatment.