Knee replacement - biologics

[Pepperpot22]

Had an appt with knee consultant today. Need a replacement done but he won’t commit to doing it until I get a ‘meds plan’ from my rheumatologist re biologics (I’ve recently started on Amgevita). He wants info on how long before surgery to stop taking it. I’m also on Methotrexate and Sulphasalazine but he wasn’t so worried about those. Has anybody else had to do this? I’d also be interested to hear of peoples experience of knee surgery when on Amgevita, especially how long they were off meds for the operation

[Madmusiclover]

Yes you need to get meds confirmed with your RA team. Varies depending on half life of drug. I’ve been able to restart once wound healed. Usually when staples/stitches come out 10 days to 2 weeks after op.

[Pepperpot22 in reply to Madmusiclover]

Thank u for reply. I will email my Rheumatologist

[Runrig01]

I’ve known a few people who’ve had hip replacement and used Amgevita. One was 11 weeks as they classed it as high risk infective surgery, the other was 6 weeks as they classed it low risk. I was an orthopaedic nurse for many years, and although the surgery itself isn’t high risk, unlike bowel surgery, if you get an infection in the joint after surgery it becomes a high risk as you can quickly develop osteomyelitis.

It may be your rheumatologist needs to discuss the risk with the surgeon. You definitely need to liase with them. The reason it’s so long is it has a half life of 20 days, and it takes 5.5 half life’s to clear, so 20x5.5, which is 110 days.

[Pepperpot22 in reply to Runrig01]

Thank u for the useful info. Crikey, stays in the system a long time!

[medway-lady]

You know this is a really interesting question because I've started the work up for major (in my view) surgery. It's not going to be quick and not yet needed but is on its way or not, if they decide on a less invasive route . But that still involves surgery anyway. So a lot more ahead but I asked this question and the Nephrologist said their advice now is to stay on meds as in the event of a flare the swelling is more damaging than any potential risk of infection. And anyway you can get called, with only hours notice so too late if already taken stuff and often they are meds used anyway to suppress rejection. God knows ! and we can only go by the informed advice of the surgeon I suppose, but I'm totally confused.

[Pepperpot22 in reply to medway-lady]

Yes, I’ll be interested to hear what my rheumatologist advice is. My worry is, the biologics are the only meds that have brought my high inflammation levels down. If I come off them for long and levels go back up they prob wudnt do surgery anyway 🤷‍♀️

[medway-lady]

My Rheumy said up to the Nephrologist if he sayes ok then he overrules her. I’ve a friend who reckons only doctor to rely on is a pathologist. But by then it doesn’t matter anyway. Cheerful out look. lol xx

[Portinatx17]

I had to stop Amgevita and Sulfasalazine for four wks preop. Methotrexate was ok. Every surgeon differs tho tbh

[Pepperpot22 in reply to Portinatx17]

Thank u for the info. Nice to hear someone else’s experience 😊

[jayne17]

I am waiting for hip surgery and on methotrexate and abatacept and my Rheumatologist says stop for 2 weeks before surgery and restart 2 weeks after if healed. Methotrexate stop 1 week before.I am a bit nervous about this because for previous surgery I am sure I stopped for 4/6 weeks.

Hope you get an answer soon and that all goes well.

[Pepperpot22 in reply to jayne17]

It does seem as though there isn’t exactly a recommended time to be off the meds & different rheumatologists hav different opinions. I too feel a bit nervous!