Rituximab operation

[65_women]

OPERATION, can you have have an operation while on Rituximab?

[Neonkittie17]

I was told you should try have any ops midway since last Rtx treatment and before the next, if possible but you can’t always know when you’ll need an op/if it’s something more urgent. I had an op with general anaesthetic around 6 months after the previous Rtx. I used to go a year between Rtx infusions. I think there’s the recommendation from most rheumys I’ve spoken to, to not plan an op too soon after Rtx as you’ll be at a low ebb but ask your rheumy for clarification on this timing.

[bpeal1]

Yes it is possible. I’ve had two complex foot surgeries (4 hours each) whilst on Rituximab. It can be a bit tricky juggling the timing of the surgery and Rituximab because you’re not sure when you’ll be top of the waiting list.

Ultimately the timing of the surgery after Rituximab is surgeon’s decision but hopefully if they’re not familiar with Rituximab they will take advice from your rheumatologist. It wouldn’t hurt to have a chat with your rheumatologist before seeing the surgeon to see what they think. Definitely flag to your surgeon that you are on Rituximab. During my surgeries the surgeon decided to give IV prophylactic antibiotics (just one dose whilst the surgery was taking place) as an extra precaution because of the nature of the surgery.

Everyone if different, our infection risk is different depending on age, medication, length of time you leave between Rituximab treatments and how well controlled our disease is (many people forget that uncontrolled RA is often more of an infection risk than the medication we take). Also the infection risk from different types of surgery is very different. Therefore there is no one size fits all and you need to take advice from your medical professionals. As I mentioned above it is the surgeon who has the ultimate say on when surgery can and can’t go ahead.

I have Rituximab every 6 months, I was advised if possible to wait 3-4 months after Rituximab before surgery. In the end it was about 2 1/2 months for the second surgery as juggling the timings and the waiting lists didn’t quite work. However, I had no problems at all.

[cathie]

I had 2 knee replacements while on rituximab. Can’t remember exact arrangement as to timing of op/ infusion but yrs

[StormySeas]

Great replies above.

I had a hip replacement whilst on RTX though it was a year after my last infusion.

Of course infection is the greatest worry and the surgeon was absolutely right on top of it, including wanting me discharged as quickly as possible after the operation, as that was considered the greatest risk.

I’m sure your surgical team will be aware of the issues but do check with them and make sure the RTX is flagged at every stage - for your own piece of mind - if nothing else.

Hope it goes well. There were no problems with my surgery

[weathervane]

I had spinal surgery, my white cell count was very low at this time so I had to have it tested weekly until it came up , the worry was infection. I was grand with no issues.

I also had a lumpectomy, wound healed well but unfortunately had to miss 2 rounds of rituximab.

The rheumatologist and the surgeons liased with both surgeries which gave me more confidence. Best wishes 🤗

[65_women in reply to weathervane]

Thank you

[Moomin8 in reply to weathervane]

Hi, could I jump in on this thread please? I wanted to ask you, weathervane, how long after your lumpectomy were you able to have a Rituximab infusion? I had a lumpectomy a month ago, and I have to have radiotherapy soon - first appointment with oncologist this week. My rheumatology nurse said I can't go back on my Tocilizumab, which was my wonder drug, due to my diagnosis of PLCIS. She suggested that I might be able to try Rituximab. I tried it before Tocilizumab, and it did nothing for me back then (2021) but it seems I have little choice.

[weathervane in reply to Moomin8]

Hi , I hope you’re making a good recovery after lumpectomy 🤗 . I had radiotherapy in the August and had rituximab again in the January. I ended up missing 2 rounds between the diagnosis, surgery and radiotherapy. It wasn’t easy but I did get a steroid shot which helped a bit. Its a pity you can’t continue with the Tocilizumab. I took 2 rounds of rituximab to get back on a more even keel again. I would make sure you see your rheumatologist again before a definitive decision is made, if possible. Good luck with everything, I hope all goes well for you xx

[Moomin8 in reply to weathervane]

Thanks for your reply ☺️I only saw her last Wednesday. She seemed adamant that I couldn't have Tocilizumab 😖My diagnosis letter from my surgeon, after they'd checked out what they'd seem from my lumpectomy, said that I was back on my rheumatology meds - very frustrating. You had to wait 6 months after your radiotherapy to have your infusion??? I'm already struggling tbh. I'll ask my oncologist about having steroids. The injection never touches the sides for me; I'm better off on Prednisolone. But surely, they make you open to infection and therefore make it harder to recover? So why can't I have my meds - this is my argument 🤔

[weathervane in reply to Moomin8]

It may not be the same for you , if your rheumy and oncologist could liase they might come up with a treatment plan for you. My white cell count is always very low , i did heal well but did develop seromas which might have caused issues re infection risk .

Im sorry to hear you are struggling at the moment, you don’t need this worry on top of everything else . 🤞🏻🤞🏻 your rheumatologist might have a be able to suggest a good alternative for you, sending you positive thoughts and best wishes xx

[Moomin8 in reply to weathervane]

The only good thing about being off my meds is that my ALT, wbc and neutrophils are now normal 😁They have been normal for a long time!

[weathervane in reply to Moomin8]

Hopefully that might be a positive factor for you. My white cell count was low before I started any treatment 🤷‍♀️