NTERNAL MEDICINE JOURNAI南RACPdot10.1111/irmj.16073POSITION PAPERAustralian recommendations on perioperative use of disease-modifying anti-rheumatic drugs in people with inflammatoryarthritis undergoing elective surgeryRachelle Buchbinder,1 Vanessa Glennon,Renea V.Johnston,'Sue E.Brennan,'Chris Fong,2Suzie Edward May,3 Sean O'Neill,4 Peter Smitham,5 Lyndal Trevena,Glen Whittaker,Anita Wluka'andSamuel L.Whittle1school of Public Health and Preventive Medicine,Monash University,2Eastem Clinical Research Unit,Eastern Health Box Hill Hospital and MonashUniversity,and 'Discipline of Podiatry,School of Allied Health,Human Services and Sport,La Trobe University,Melbourne,Victoria,ConsumerRepresentative,Giving Voice,Perth,Western Australia,Sydney Musculoskeletal Health Flagship,University of Sydney Northern Clinical School andRoyal North Shore Hospital,and "Faculty of Medicine and Health,University of Sydney,Sydney,New South Wales,and Orthopaedic TraumaDepartment,Royal Adelaide Hospital Discipline of Orthopaedics,University of Adelaide,and Rheumatology Unit,Queen Elizabeth Hospital,Adelaide,South Australia,AustraliaKey wordsAbstractinflammatory arthritis,perioperative use,disease-modifying anti-rheumatic drugs,livingDisease-modifying anti-rheumatic drugs (DMARDs)are effedive treatments for inflamma-guidelines.tory arthritis but carry an increased risk of infection.For patients undergoing surgery,thereis a need to consider the trade-off between a theoretical increased risk of infection with conCorrespondencetinuation of DMARDs perioperatively versus an increased risk of disease flare if they areRachelle Buchbinder,School of Public Healthtemporarily withheld.We used the Grading of Recommendations Assessment.Develop-and Preventive Medicine,Monash University,ment and Evaluation methodology to develop recommendations for perioperative use ofLevel 4,553 St Kilda Rd,Melboume,Vic.,3004,DMARDs for people with inflammatory arthritis undergoing elective surgery.The recom-Australia.mendations form part of the National Health and Medical Researd Coundl-endorsedEmail:rachelle.buchbinder@monash.eduAustralian Living Guideline for the Pharmacological Management of Inflammatory Arthritis.Conditional recommendations were made against routinely discontinuing conventional syn-Received 23 October 2022;acceptedthetic and biologic (b)DMARDs in the perioperative period but to consider temporary dis6 March 2023.continuation of bDMARDs in individuals with a high risk of infection or where the impactof infedion would be severe.A conditional recommendation was made in favour of tempo-rary discontinuation of targeted synthetic DMARDs in the perioperative period.Introductionperioperative period,versus an increased risk of diseaseDisease-modifying anti-rheumatic drugs (DMARDs).flare if these medications are temporarily withheld.Theperioperative period is generally defined as the periodinduding conventional synthetic (cs),biologic (b)andaround the time of the surgical operation,including
