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Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab.

Hirao M, Hashimoto J, Tsuboi H, Nampei A, Nakahara H, Yoshio N, Mima T, Yoshikawa H, Nishimoto N - Ann. Rheum. Dis. (2008)

Bottom Line: Tocilizumab partially, but significantly, suppressed the increase in body temperature on postoperative days 1 and 2, compared with DMARDs (average (SD) maximum increase in temperature was 0.45 (0.1) degrees C in the tocilizumab group and 0.78 (0.1) degrees C in the DMARD group; p<0.01).Within this small number of cases, safe operations on patients were performed during tocilizumab treatment.This characteristic postoperative response should be considered during tocilizumab treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.

ABSTRACT

Objectives: To understand the acute phase responses to surgical intervention in patients with rheumatoid arthritis (RA) treated with the anti-interleukin (IL)6 receptor antibody, tocilizumab.

Methods: In a retrospective 1:1 pair-matched case-control study, 22 tocilizumab-treated RA cases and 22 cases treated with conventional disease-modifying antirheumatic drugs (DMARDs) and matched for type of surgery, age and sex were evaluated for body temperature every day, and blood C-reactive protein (CRP) levels and white blood cell (WBC), neutrophil and lymphocyte counts on days -1, 1, 3 and weeks 1 and 2 after joint surgery. Safety issues were also monitored.

Results: No complications of infection or delay of wound healing occurred in either patient group. Tocilizumab partially, but significantly, suppressed the increase in body temperature on postoperative days 1 and 2, compared with DMARDs (average (SD) maximum increase in temperature was 0.45 (0.1) degrees C in the tocilizumab group and 0.78 (0.1) degrees C in the DMARD group; p<0.01). Tocilizumab completely suppressed the increase in CRP after surgery, whereas all cases treated with DMARDs showed a significant increase of CRP at postoperative day 1 (5.5 (0.6) mg/dl; p<0.001). WBC, neutrophil and lymphocyte counts showed no remarkable change after surgery, and there was no significant difference in any cell counts between the patient groups.

Conclusions: Within this small number of cases, safe operations on patients were performed during tocilizumab treatment. Tocilizumab suppressed fever and increase of CRP after surgery, whereas there was no influence on the transition in number of leukocytes. This characteristic postoperative response should be considered during tocilizumab treatment.

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Related in: MedlinePlus

Changes in body temperature, C-reactive protein (CRP) levels and numbers of white blood cells (WBCs; neutrophils and lymphocytes) after surgery. Values are mean (SD). *Significant difference, as compared to values before surgery. NS, no significant difference between the two groups. Dotted lines: disease-modifying antirheumatic drug (DMARD) group. Unbroken lines: tocilizumab group. A. Graph shows the change in body temperature, as compared before surgery. p: p Value for the difference between the DMARD group and the tocilizumab group. B. Graph shows the absolute value of CRP level. p: p Value for the difference between the two groups. C. Graph shows the percentage change in total number of WBCs. D. Graph shows the percentage change in numbers of neutrophils. E. Graph shows the percentage change in numbers of lymphocytes.
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ard-68-05-0654-f01: Changes in body temperature, C-reactive protein (CRP) levels and numbers of white blood cells (WBCs; neutrophils and lymphocytes) after surgery. Values are mean (SD). *Significant difference, as compared to values before surgery. NS, no significant difference between the two groups. Dotted lines: disease-modifying antirheumatic drug (DMARD) group. Unbroken lines: tocilizumab group. A. Graph shows the change in body temperature, as compared before surgery. p: p Value for the difference between the DMARD group and the tocilizumab group. B. Graph shows the absolute value of CRP level. p: p Value for the difference between the two groups. C. Graph shows the percentage change in total number of WBCs. D. Graph shows the percentage change in numbers of neutrophils. E. Graph shows the percentage change in numbers of lymphocytes.

Mentions: As shown in table 1, there was no significant difference in preoperative body temperature between the tocilizumab and the DMARD groups. Both groups showed significant increases in body temperature, as compared with that of the preoperative day (fig 1). The expected increase in body temperature following surgery was significantly suppressed in the tocilizumab group (fig 1). Average maximum increase in body temperature was 0.78 (0.1)°C in the DMARD group and 0.45 (0.1)°C in the tocilizumab group.


Laboratory and febrile features after joint surgery in patients with rheumatoid arthritis treated with tocilizumab.

Hirao M, Hashimoto J, Tsuboi H, Nampei A, Nakahara H, Yoshio N, Mima T, Yoshikawa H, Nishimoto N - Ann. Rheum. Dis. (2008)

Changes in body temperature, C-reactive protein (CRP) levels and numbers of white blood cells (WBCs; neutrophils and lymphocytes) after surgery. Values are mean (SD). *Significant difference, as compared to values before surgery. NS, no significant difference between the two groups. Dotted lines: disease-modifying antirheumatic drug (DMARD) group. Unbroken lines: tocilizumab group. A. Graph shows the change in body temperature, as compared before surgery. p: p Value for the difference between the DMARD group and the tocilizumab group. B. Graph shows the absolute value of CRP level. p: p Value for the difference between the two groups. C. Graph shows the percentage change in total number of WBCs. D. Graph shows the percentage change in numbers of neutrophils. E. Graph shows the percentage change in numbers of lymphocytes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2663710&req=5

ard-68-05-0654-f01: Changes in body temperature, C-reactive protein (CRP) levels and numbers of white blood cells (WBCs; neutrophils and lymphocytes) after surgery. Values are mean (SD). *Significant difference, as compared to values before surgery. NS, no significant difference between the two groups. Dotted lines: disease-modifying antirheumatic drug (DMARD) group. Unbroken lines: tocilizumab group. A. Graph shows the change in body temperature, as compared before surgery. p: p Value for the difference between the DMARD group and the tocilizumab group. B. Graph shows the absolute value of CRP level. p: p Value for the difference between the two groups. C. Graph shows the percentage change in total number of WBCs. D. Graph shows the percentage change in numbers of neutrophils. E. Graph shows the percentage change in numbers of lymphocytes.
Mentions: As shown in table 1, there was no significant difference in preoperative body temperature between the tocilizumab and the DMARD groups. Both groups showed significant increases in body temperature, as compared with that of the preoperative day (fig 1). The expected increase in body temperature following surgery was significantly suppressed in the tocilizumab group (fig 1). Average maximum increase in body temperature was 0.78 (0.1)°C in the DMARD group and 0.45 (0.1)°C in the tocilizumab group.

Bottom Line: Tocilizumab partially, but significantly, suppressed the increase in body temperature on postoperative days 1 and 2, compared with DMARDs (average (SD) maximum increase in temperature was 0.45 (0.1) degrees C in the tocilizumab group and 0.78 (0.1) degrees C in the DMARD group; p<0.01).Within this small number of cases, safe operations on patients were performed during tocilizumab treatment.This characteristic postoperative response should be considered during tocilizumab treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.

ABSTRACT

Objectives: To understand the acute phase responses to surgical intervention in patients with rheumatoid arthritis (RA) treated with the anti-interleukin (IL)6 receptor antibody, tocilizumab.

Methods: In a retrospective 1:1 pair-matched case-control study, 22 tocilizumab-treated RA cases and 22 cases treated with conventional disease-modifying antirheumatic drugs (DMARDs) and matched for type of surgery, age and sex were evaluated for body temperature every day, and blood C-reactive protein (CRP) levels and white blood cell (WBC), neutrophil and lymphocyte counts on days -1, 1, 3 and weeks 1 and 2 after joint surgery. Safety issues were also monitored.

Results: No complications of infection or delay of wound healing occurred in either patient group. Tocilizumab partially, but significantly, suppressed the increase in body temperature on postoperative days 1 and 2, compared with DMARDs (average (SD) maximum increase in temperature was 0.45 (0.1) degrees C in the tocilizumab group and 0.78 (0.1) degrees C in the DMARD group; p<0.01). Tocilizumab completely suppressed the increase in CRP after surgery, whereas all cases treated with DMARDs showed a significant increase of CRP at postoperative day 1 (5.5 (0.6) mg/dl; p<0.001). WBC, neutrophil and lymphocyte counts showed no remarkable change after surgery, and there was no significant difference in any cell counts between the patient groups.

Conclusions: Within this small number of cases, safe operations on patients were performed during tocilizumab treatment. Tocilizumab suppressed fever and increase of CRP after surgery, whereas there was no influence on the transition in number of leukocytes. This characteristic postoperative response should be considered during tocilizumab treatment.

Show MeSH
Related in: MedlinePlus