Perioperative Management of Biologic Disease-Modifying Antirheumatic Drugs in Patients with Inflammatory Rheumatic Diseases Undergoing Total Joint Arthroplasty: A Nationwide Population-Based Cohort Study from Taiwan

Background The optimal perioperative management of biologic disease-modifying antirheumatic drugs (bDMARDs) in inflammatory rheumatic disease (IRD) patients undergoing total joint arthroplasty (TJA) remains debated, with current guidelines based on low-to-moderate quality evidence. Methods Using the Taiwan National Health Insurance Research Database (NHIRD, 2004–2020), we identified IRD patients undergoing primary TJA and propensity score-matched them with non-IRD controls. Within the IRD cohort, patients were categorized by perioperative bDMARD strategy: continuation (n=623) versus withholding (n=631). Primary outcomes included surgical site infection (SSI), delayed wound healing, and disease flares within 30 days. Results Among 1,254 propensity-matched IRD patients, SSI rates were comparable between continuation and withholding groups, consistent with prior studies [ 12 , 17 ] (2.91% vs 2.51%; OR 1.31, p=0.39), as was delayed wound healing (2.21% vs 1.09%; OR 2.02, p=0.43). Disease flares were significantly lower with continuation (6.12% vs 22.33%; OR 0.13, p=0.03). Healthcare costs were lower in the continuation group. Conclusions Perioperative bDMARD continuation was not associated with a significantly increased risk of SSI or wound complications but substantially reduced disease flares. Blanket bDMARD discontinuation may not be warranted, supporting individualized perioperative management.