Wound Healing and Anti-Rheumatic Agents

Patients with rheumatoid arthritis (RA) are often on multiple medications to control disease activity and these medications may have significant toxicities, including effects on wound healing. Deep surgical site infections are of particular concern when prostheses such as arthroplasties are implanted, given the morbidity, mortality, and expense associated with prosthetic joint infection. Wound healing complications, including prolonged drainage or superficial infection, are highly associated with deep surgical site infection, so medications which delay wound healing following elective surgery are particularly worrisome(1). However, active RA also confers an increased risk for infection(2) and slows post-operative mobilization, so perioperative management strategies must balance the risks. Because poor wound healing often leads to infection (e.g. up to 50% of diabetic foot ulcers will become infected(3), and infection often contributes to delayed wound healing) it is often difficult to disentangle infection from poor wound healing in the postoperative period. This review will concentrate on the effects of anti-rheumatic therapy on wound healing, and identify those effects which are well documented versus those which are less well studied. This review will not address the effects of therapy on fracture healing.