Yonsei Med J.  2013 Jan;54(1):253-257. 10.3349/ymj.2013.54.1.253.

Patients with Arthritis Undergoing Surgery: How Should We Manage Tumour Necrosis Factor Blocking Agents Perioperatively?: A Systematic Literature Review

  • 1Section of Rheumatology, 2nd Department of Medicine, General Hospital Linz, Linz, Austria. herwigpi@yahoo.com
  • 2Paracelsus Medical University, Salzburg, Austria.
  • 3Department of Pediatric Rheumatology, Klinikum Bad Bramstedt, Bad Bramstedt, Germany.
  • 4Department of Orthopedics and Orthopedic Surgery, General Hospital Linz, Linz, Austria.
  • 5Internal Medicine III, Medical University Vienna, Vienna, Austria.
  • 6Rheumatology Unit, Clinical Department of General Internal Medicine, Innsbruck Medical University, Innsbruck, Austria.


We systematically reviewed the literature on the infectious risk in patients treated with tumour necrosis factor blocking agents (TNF-BA) undergoing surgery: we searched the Medline (PubMed) and the online archive from the Annual European Congress of Rheumatology and the Annual Scientific Meeting of the American College of Rheumatology. Of total 1259 reports, 14 were finally analysed. With one exception all were retrospective. Four of 6 studies compared patients on TNF-BA with those not receiving TNF-BA, and found an increased risk of infection with the use of TNF-BA. None of the other studies which compared continued with discontinued treatment at surgery found an increased risk of infection, when the medication was continued perioperatively. In conclusion, while in theory there is an increased risk of infections when TNF-BA are administered perioperatively, the available literature does not necessarily support this. It rather appears that patients receiving TNF-BA are a priori at a higher risk of postoperative infections. Scheduling surgery at the end of the drug interval and adding one "safety" week prior to surgery should be an acceptable plan in daily clinical practice.


Surgery; arthritis; tumour necrosis factor blocking agents; infection

MeSH Terms

Antibodies, Monoclonal/therapeutic use
Antibodies, Monoclonal, Humanized/therapeutic use
Antirheumatic Agents/therapeutic use
Immunoglobulin Fab Fragments/therapeutic use
Immunoglobulin G/therapeutic use
Perioperative Period
Polyethylene Glycols/therapeutic use
Postoperative Complications/prevention & control
Postoperative Period
Receptors, Tumor Necrosis Factor/therapeutic use
Retrospective Studies
Tumor Necrosis Factor-alpha/*antagonists & inhibitors
Antibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Antirheumatic Agents
Immunoglobulin Fab Fragments
Immunoglobulin G
Polyethylene Glycols
Receptors, Tumor Necrosis Factor
Tumor Necrosis Factor-alpha
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