• Rachelle Buchbinder, Vanessa Glennon, Renea V Johnston, Sue E Brennan, Chris Fong, Suzie Edward May, Sean O'Neill, Peter Smitham, Lyndal Trevena, Glen Whittaker, Anita Wluka, and Samuel L Whittle.
• School of Public Health and Preventive Medicine, Monash University, Victoria, Melbourne, Australia.
• Intern Med J. 2023 Jul 1; 53 (7): 124812551248-1255.

AbstractDisease-modifying anti-rheumatic drugs (DMARDs) are effective treatments for inflammatory arthritis but carry an increased risk of infection. For patients undergoing surgery, there is a need to consider the trade-off between a theoretical increased risk of infection with continuation of DMARDs perioperatively versus an increased risk of disease flare if they are temporarily withheld. We used the Grading of Recommendations Assessment, Development and Evaluation methodology to develop recommendations for perioperative use of DMARDs for people with inflammatory arthritis undergoing elective surgery. The recommendations form part of the National Health and Medical Research Council-endorsed Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis. Conditional recommendations were made against routinely discontinuing conventional synthetic and biologic (b) DMARDs in the perioperative period but to consider temporary discontinuation of bDMARDs in individuals with a high risk of infection or where the impact of infection would be severe. A conditional recommendation was made in favour of temporary discontinuation of targeted synthetic DMARDs in the perioperative period.© 2023 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

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