Biologic Perioperative Management — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyBiologic Perioperative ManagementSCE Rheumatology

A 42-year-old woman with RA on Adalimumab requires an elective total knee replacement. According to BSR guidelines what is the recommended timing for withholding Adalimumab around surgery?

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Correct answer: A — Omit one adalimumab dosing interval

BSR biologic safety guidelines recommend withholding biologic therapy for one dosing interval (cycle) before elective surgery to reduce perioperative infection risk. For Adalimumab (given fortnightly) this means omitting the dose immediately before the planned surgery date. Biologic therapy should be restarted once the surgical wound has healed satisfactorily and there is no evidence of infection (typically 2 weeks after uncomplicated surgery). Methotrexate can generally be continued perioperatively as stopping it increases flare risk without clear evidence of increased infection. This approach balances infection risk reduction with disease activity control.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions