From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis
Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing...
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| Veröffentlicht in: | Journal of the American Academy of Dermatology 2016-10, Vol.75 (4), p.798-805.e7 |
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| container_title | Journal of the American Academy of Dermatology |
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| creator | Choi, Young M., MD Debbaneh, Maya, MD Weinberg, Jeffrey M., MD Yamauchi, Paul S., MD, PhD Van Voorhees, Abby S., MD Armstrong, April W., MD, MPH Siegel, Michael, PhD Wu, Jashin J., MD |
| description | Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities. |
| doi_str_mv | 10.1016/j.jaad.2016.06.014 |
| format | Article |
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In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.</description><identifier>ISSN: 0190-9622</identifier><identifier>EISSN: 1097-6787</identifier><identifier>DOI: 10.1016/j.jaad.2016.06.014</identifier><identifier>PMID: 27461230</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arthritis, Psoriatic - diagnosis ; Arthritis, Psoriatic - drug therapy ; Arthritis, Psoriatic - surgery ; biologic ; cyclosporine ; Dermatology ; Female ; Humans ; Immunologic Factors - pharmacology ; Immunologic Factors - therapeutic use ; Immunomodulation ; immunosuppressant ; Male ; methotrexate ; Patient Safety ; perioperative ; Perioperative Care - methods ; Practice Guidelines as Topic ; Prognosis ; psoriasis ; Psoriasis - diagnosis ; Psoriasis - drug therapy ; Psoriasis - surgery ; psoriatic arthritis ; Risk Assessment ; Societies, Medical ; Specialty Boards ; Surgical Procedures, Operative - methods ; Treatment Outcome ; tumor necrosis factor-alfa inhibitor</subject><ispartof>Journal of the American Academy of Dermatology, 2016-10, Vol.75 (4), p.798-805.e7</ispartof><rights>American Academy of Dermatology, Inc.</rights><rights>2016 American Academy of Dermatology, Inc.</rights><rights>Copyright © 2016 American Academy of Dermatology, Inc. 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In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.</description><subject>Arthritis, Psoriatic - diagnosis</subject><subject>Arthritis, Psoriatic - drug therapy</subject><subject>Arthritis, Psoriatic - surgery</subject><subject>biologic</subject><subject>cyclosporine</subject><subject>Dermatology</subject><subject>Female</subject><subject>Humans</subject><subject>Immunologic Factors - pharmacology</subject><subject>Immunologic Factors - therapeutic use</subject><subject>Immunomodulation</subject><subject>immunosuppressant</subject><subject>Male</subject><subject>methotrexate</subject><subject>Patient Safety</subject><subject>perioperative</subject><subject>Perioperative Care - methods</subject><subject>Practice Guidelines as Topic</subject><subject>Prognosis</subject><subject>psoriasis</subject><subject>Psoriasis - diagnosis</subject><subject>Psoriasis - drug therapy</subject><subject>Psoriasis - surgery</subject><subject>psoriatic arthritis</subject><subject>Risk Assessment</subject><subject>Societies, Medical</subject><subject>Specialty Boards</subject><subject>Surgical Procedures, Operative - methods</subject><subject>Treatment Outcome</subject><subject>tumor necrosis factor-alfa inhibitor</subject><issn>0190-9622</issn><issn>1097-6787</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UsGO0zAQtRCI7S78AAfkI5cUT-LGMUJIsKKAtMBKwNly7Ql1SeKs7SzqP-1H4rRlDxyQRvLM6L03Gr8h5BmwJTCoX-6WO63tssz5kuUA_oAsgElR1KIRD8mCgWSFrMvyjJzHuGOMSV6Jx-SsFLyGsmILcrcOvqdpi_QzWmd0R995HSz17aH5RSfnh9y9jj44HV2kaz8N9tB-Ra8xOD9iyOUt0l4P-if2OKSZHvcxYe8MdX0_Db73dup08mFPM2hIkbqBjpl4yH-7tKXj_Qw92FOVsoAOaRtccvEJedTqLuLT03tBfqzff7_8WFx9_fDp8u1VYThAKpoWm7YCXmsO9cpysWFcwMZqzRoDDav1SshW1tBULTdSWqwFcosrqDSwhlUX5MVRdwz-ZsKYVO-iwa7TA_opKmjKEkBwKTO0PEJN8DEGbNUYXK_DXgFTs0tqp2aX1OySYjmAZ9Lzk_606dHeU_7akgGvjwDMW946DCqa_FEmWxTQJGW9-7_-m3_opnPD7O4v3GPc-SlkT_MeKpaKqW_zncxnAnWeLUFUfwDT6bwo</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Choi, Young M., MD</creator><creator>Debbaneh, Maya, MD</creator><creator>Weinberg, Jeffrey M., MD</creator><creator>Yamauchi, Paul S., MD, PhD</creator><creator>Van Voorhees, Abby S., MD</creator><creator>Armstrong, April W., MD, MPH</creator><creator>Siegel, Michael, PhD</creator><creator>Wu, Jashin J., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161001</creationdate><title>From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis</title><author>Choi, Young M., MD ; Debbaneh, Maya, MD ; Weinberg, Jeffrey M., MD ; Yamauchi, Paul S., MD, PhD ; Van Voorhees, Abby S., MD ; Armstrong, April W., MD, MPH ; Siegel, Michael, PhD ; Wu, Jashin J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-8fe8f3146a4165d47b0471bdaa08c1806a579f96183f4c99de67e4de513a10803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Arthritis, Psoriatic - diagnosis</topic><topic>Arthritis, Psoriatic - drug therapy</topic><topic>Arthritis, Psoriatic - surgery</topic><topic>biologic</topic><topic>cyclosporine</topic><topic>Dermatology</topic><topic>Female</topic><topic>Humans</topic><topic>Immunologic Factors - pharmacology</topic><topic>Immunologic Factors - therapeutic use</topic><topic>Immunomodulation</topic><topic>immunosuppressant</topic><topic>Male</topic><topic>methotrexate</topic><topic>Patient Safety</topic><topic>perioperative</topic><topic>Perioperative Care - methods</topic><topic>Practice Guidelines as Topic</topic><topic>Prognosis</topic><topic>psoriasis</topic><topic>Psoriasis - diagnosis</topic><topic>Psoriasis - drug therapy</topic><topic>Psoriasis - surgery</topic><topic>psoriatic arthritis</topic><topic>Risk Assessment</topic><topic>Societies, Medical</topic><topic>Specialty Boards</topic><topic>Surgical Procedures, Operative - methods</topic><topic>Treatment Outcome</topic><topic>tumor necrosis factor-alfa inhibitor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Choi, Young M., MD</creatorcontrib><creatorcontrib>Debbaneh, Maya, MD</creatorcontrib><creatorcontrib>Weinberg, Jeffrey M., MD</creatorcontrib><creatorcontrib>Yamauchi, Paul S., MD, PhD</creatorcontrib><creatorcontrib>Van Voorhees, Abby S., MD</creatorcontrib><creatorcontrib>Armstrong, April W., MD, MPH</creatorcontrib><creatorcontrib>Siegel, Michael, PhD</creatorcontrib><creatorcontrib>Wu, Jashin J., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Academy of Dermatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Choi, Young M., MD</au><au>Debbaneh, Maya, MD</au><au>Weinberg, Jeffrey M., MD</au><au>Yamauchi, Paul S., MD, PhD</au><au>Van Voorhees, Abby S., MD</au><au>Armstrong, April W., MD, MPH</au><au>Siegel, Michael, PhD</au><au>Wu, Jashin J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis</atitle><jtitle>Journal of the American Academy of Dermatology</jtitle><addtitle>J Am Acad Dermatol</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>75</volume><issue>4</issue><spage>798</spage><epage>805.e7</epage><pages>798-805.e7</pages><issn>0190-9622</issn><eissn>1097-6787</eissn><abstract>Treatment with systemic immunomodulatory agents is indicated for patients with moderate to severe plaque psoriasis and psoriatic arthritis. In these patients, surgery may confer an increased risk of infectious or surgical complications. We conducted a literature review to examine studies addressing the use of methotrexate, cyclosporine, and targeted immunomodulatory agents (tumor necrosis factor-alfa inhibitors, interleukin [IL]-12/23 inhibitors, IL-17 inhibitors) in patients undergoing surgery. We examined 46 total studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease. One study in patients with psoriasis and psoriatic arthritis reviewed 77 procedures and did not find an elevated risk of postoperative complications with tumor necrosis factor-alfa and IL-12/23 inhibitors even with major surgeries. Based on level III evidence, infliximab, adalimumab, etanercept, methotrexate, and cyclosporine can be safely continued through low-risk operations in patients with psoriasis and psoriatic arthritis. For moderate- and high-risk surgeries, a case-by-case approach should be taken based on the patient's individual risk factors and comorbidities.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27461230</pmid><doi>10.1016/j.jaad.2016.06.014</doi></addata></record> |
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| ispartof | Journal of the American Academy of Dermatology, 2016-10, Vol.75 (4), p.798-805.e7 |
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| subjects | Arthritis, Psoriatic - diagnosis Arthritis, Psoriatic - drug therapy Arthritis, Psoriatic - surgery biologic cyclosporine Dermatology Female Humans Immunologic Factors - pharmacology Immunologic Factors - therapeutic use Immunomodulation immunosuppressant Male methotrexate Patient Safety perioperative Perioperative Care - methods Practice Guidelines as Topic Prognosis psoriasis Psoriasis - diagnosis Psoriasis - drug therapy Psoriasis - surgery psoriatic arthritis Risk Assessment Societies, Medical Specialty Boards Surgical Procedures, Operative - methods Treatment Outcome tumor necrosis factor-alfa inhibitor |
| title | From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis |
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