Orencia (Abatacept) is NOT a Contraindication to Joint Steroid Injections
Orencia (abatacept) treatment does not represent a contraindication to intraarticular corticosteroid injections, and these injections can be safely administered to patients on abatacept therapy for rheumatoid arthritis or other inflammatory conditions. 1, 2
Evidence Supporting Safety of Joint Injections on Abatacept
No Specific Contraindications Identified
Current EULAR recommendations for intra-articular therapies do not list biologic DMARDs, including abatacept, as contraindications to intraarticular corticosteroid injections 1
The primary contraindication to intraarticular steroids is the absence of an appropriate diagnosis and the presence of infection, not concurrent biologic therapy 1
Real-World Safety Data
Data from the French Orencia RA registry, which followed 1,012 patients on abatacept, demonstrated that surgical procedures (including joint surgeries) had low complication rates of 7.2%, with surgical site infections occurring in only 2.3% of cases 2
The median time between abatacept infusion and surgery was 5.9 weeks, and importantly, this timing did not significantly influence complication rates 2
Serious infection rates in patients treated with abatacept in real-world practice were 4.1 per 100 patient-years, with age and history of previous serious infections being the primary risk factors—not the use of concurrent procedures 3
Clinical Approach to Joint Injections in Patients on Abatacept
When to Use Intraarticular Corticosteroids
For rheumatoid arthritis patients on abatacept: Intraarticular corticosteroid injections are recommended for residual active joints as part of therapy optimization, particularly when one or few joints remain symptomatic despite systemic treatment 1
For osteoarthritis patients on abatacept: Intraarticular glucocorticoid injections are strongly recommended for knee and hip OA and conditionally recommended for hand OA, regardless of concurrent biologic therapy 1
For acute flares: Intraarticular corticosteroids are first-line options for acute joint flares with effusion, even in patients on biologic therapy 1
Practical Considerations
Avoid overuse of the injected joint for 24 hours following injection, though immobilization is discouraged 1
Higher corticosteroid doses (oral) were associated with increased surgical complications in the registry data, so minimize systemic corticosteroid burden when possible 2
The decision to inject should follow shared decision-making, considering benefits from previous injections and individual factors including current systemic treatments 1
Important Caveats
Infection Risk Factors to Monitor
The primary concern with any invasive procedure in patients on immunosuppressive therapy is infection risk, but this is related to patient-specific factors rather than the abatacept itself 3
Key risk factors for serious infections include older age and history of previous serious or recurrent infections—not the concurrent use of abatacept with joint injections 3
Timing Considerations
Unlike some recommendations for spacing injections before elective joint replacement surgery (where a 3-month interval is suggested), there is no evidence requiring specific timing between abatacept infusions and therapeutic joint injections 4, 2
The short median time between abatacept infusion and surgical procedures (5.9 weeks) without increased complications suggests that therapeutic joint injections can be performed at any point in the abatacept treatment cycle 2
Ultrasound Guidance
For hip joint injections, ultrasound guidance is strongly recommended to ensure accurate intra-articular delivery, regardless of concurrent biologic therapy 1
For knee and hand joints, ultrasound guidance may help ensure accurate delivery but is not required 1
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