Patients with and without rheumatoid arthritis benefit equally from preoperative epoetin-α treatment

Abstract

Background Preoperative epoetin-α administration is said to have a limited effect in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA), due to lower iron availability. We studied the effects of preoperative epoetin-α treatment in orthopedic surgery patients in a daily life setting in which iron supplementation was assured, and compared the effects in RA and non-RA patients. Methods In an open, naturalistic, randomized controlled trial, 695 orthopedic surgery patients with preoperative hemoglobin (Hb) values of 10–13 g/dL, either with RA (113) or without RA (582), received either preoperative epoetin-α treatment added to standard care, or standard care alone. Hb values and transfusions were evaluated from entry into the study until 4–6 weeks after surgery. Results Both in RA and non-RA patients, perioperative Hb values were significantly higher and transfusion requirements were significantly lower in epoetin-α treated patients than in control patients (p < 0.001). In RA patients, the outcomes regarding Hb values were not significantly or relevantly different from non-RA patients. Interpretation Just as with orthopedic patients in general, RA patients benefit from preoperative epoetin-α treatment in combination with iron supplementation. We postulate that iron supplementation during epoetin-α therapy in RA patients is important for optimal efficacy.