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Hydroxychloroquine/prednisone Adjacent segment disease and wound dehiscence: 2 case reports

A multi-centre, retrospective study of 39 patients, who underwent spine surgery between January 2008 and March 2017, described two patients, of whom, a 76-year-old woman developed adjacent segment disease (ASD) following treatment with hydroxychloroquine for rheumatoid arthritis (RA), whereas a 64-year-old patient* [sex not stated] developed wound dehiscence during treatment with prednisone for RA [dosages, routes and times to reactions onsets not stated]. The 76-year-old woman, who had osteoporosis, hypertension, hyperlipidaemia, hypothyroidism, chronic kidney disease and irritable bowel syndrome, started receiving dual therapy of hydroxychloroquine and prednisone for RA. She underwent posterior instrumented arthrodesis of the craniovertebral junction (from occiput to C3), while continuing hydroxychloroquine. However, the therapy course of hydroxychloroquine was complicated by ASD and hence, it required revision of surgery for extension of fusion to T2. The 64-year-old patient, who had hypertension, hyperlipidaemia, Crest syndrome and parkinsonism, started receiving dual therapy of leflunomide and prednisone for RA. The patient underwent posterior instrumented arthrodesis of the craniovertebral junction (C1-C6). The therapy with leflunomide was discontinued prior to surgery. However, the therapy course of prednisone was complicated by wound dehiscence and hence, it required debridement and closure of the wound after 6 weeks. Post-operatively, the patient exhibited pneumonia, dysphagia (required gastrostomy-tube insertion) and deep vein thrombosis. * The gender of 64-year-old patient was mentioned as female in table no. 4 and male in table no. 5 of the article, hence not considered. Elia CJ, et al. Impact of chronic DMARD therapy in patients with rheumatoid arthritis undergoing surgery of the craniovertebral junction: A multi-center retrospective study. 803500027 Spine 45: 930-936, No. 13, Jul 2020. Available from: URL: http://doi.org/10.1097/BRS.0000000000003402

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Reactions 5 Sep 2020 No. 1820