From the Guidelines
Methotrexate (MTX) can be safely continued in the perioperative period for patients with rheumatoid arthritis (RA) undergoing elective orthopedic surgery, as it does not increase the risk of postoperative complications and may reduce RA flares. This recommendation is based on the most recent and highest quality evidence available, including a multinational study published in the Annals of the Rheumatic Diseases in 2009 1. The study found that continuing methotrexate in the perioperative period did not increase the risk of wound morbidity or postoperative infections, and actually reduced the risk of RA flares.
Key points to consider when making this decision include:
- The dose of methotrexate, with most studies using a mean dose of 10 mg/week
- The type of surgery, with most evidence supporting the safety of continuing methotrexate for elective orthopedic surgery
- The risk of RA flares, which may be reduced by continuing methotrexate in the perioperative period
- The potential risks of stopping methotrexate, including an increased risk of RA flares and disease activity
In terms of specific evidence, a randomized controlled trial (RCT) found no differences in postoperative complications between patients who continued or stopped methotrexate 1. Another RCT found that patients who continued methotrexate reported significantly fewer RA flares than patients who stopped methotrexate 1. A prospective cohort study found that postoperative infections occurred in 30% of patients who continued methotrexate, but this study had limitations and the results should be interpreted with caution 1. A multivariate analysis of another cohort study found that the perioperative use of methotrexate was not associated with wound morbidity and significantly reduced RA flares 1.
Overall, the evidence suggests that continuing methotrexate in the perioperative period for patients with RA undergoing elective orthopedic surgery is safe and may reduce the risk of RA flares. This decision should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
From the Research
Relationship Between Orthopedics and Methotrexate (MTX)
There are no research papers to assist in answering this question, as none of the provided studies mention methotrexate (MTX) in relation to orthopedics.
Available Information on Orthopedics and Pain Management
- The studies provided focus on the use of acetaminophen, ibuprofen, and other analgesics for pain management in orthopedic patients 2, 3, 4, 5, 6.
- Acetaminophen has been shown to be effective in reducing postoperative pain in orthopedic patients, but its effectiveness compared to other analgesics such as ibuprofen is still being researched 2, 5, 6.
- Ibuprofen has been found to be more effective than acetaminophen in reducing pain and improving functional status in patients with osteoarthritis 3.
- The combination of paracetamol (acetaminophen) and ibuprofen has been shown to reduce morphine consumption in patients undergoing total hip arthroplasty, but its effectiveness compared to ibuprofen alone is still being researched 6.