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Biologic and surgery — SCE Rheumatology MCQ

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ModerateRheumatological PharmacologyBiologic and surgerySCE Rheumatology

A 61-year-old man on adalimumab and methotrexate for rheumatoid arthritis is scheduled for elective total knee replacement. Disease is stable and he has no infection. The surgical team asks about peri-operative immunosuppression planning. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Time adalimumab withholding around surgery and restart after wound healing

Explanation lettering: D = shown as B · E = shown as C · C = shown as D · B = shown as E

Time adalimumab withholding around surgery and restart after wound healing is best because biologics are usually withheld for an appropriate dosing interval before major surgery and restarted once healing is satisfactory and infection absent. A is less suitable because continuing without planning may increase infection risk; B is less suitable because rituximab before surgery is not an infection-prevention strategy; C is less suitable because methotrexate is often continued in stable patients and should not be stopped permanently by default; E is less suitable because high-dose prednisolone increases infection and wound risk. Clinical pearl: peri-operative plans balance flare risk against infection and wound-healing risk.

Reference: BSR bDMARD safety guideline 2019; BNF