Recommendations for Immunomodulatory Medications with Joint Replacement Surgery

A joint committee of Rheumatologists and Orthopedic Surgeons has issued the following recommendations for medication management around hip and knee replacement:

  • Synthetic disease modifying antirheumatic drugs (DMARDs) such as methotrexate, leflunomide, hydroxychloroquine can be taken up to and through the post operative period. There is no need to hold these medications before surgery.

  • Biologic agents such as Remicade, Orencia, Humira, Enbrel, Actemra should be held 1 cycle before surgery. For example, hold Enbrel the week before, or have the surgery done just before the next IV dose of Remicade, Actemra, Orencia.

  • These agents can be restarted when the wound is clean and there is no drainage, approximately 14 days.

  • Xeljanz should be held 7 days before surgery.

  • Patients with severe lupus should continue medication up to and after surgery.

  • Patients with mild lupus should hold medication 1 week before surgery.

  • There is no reason to increase steroid dose with surgery, just continue usual dose.