Question
I am on remicade and methotrexate and need a total knee replacement are there any information on this, and should I stop the remicade and methotrexate before i have the surgery and how long before since the drugs make you more prone to have infections.
Answer
There is not a lot of good scientific information to tell us exactly what to do. In my practice, I stop methotrexate 1 week prior to surgery and restart 2 weeks after surgery. Remicade is trickier. Since most patients are receiving Remicade every 8 weeks, I tell patients to try to plan the surgery about 6 weeks after the last Remicade infusion and then if the surgery goes well without post-op infections, then restart the Remicade 2-4 weeks after the surgery. You need to balance the possibility of an increased risk of infection versus the risk of an RA flare.
