Stopping or continuing biologics before orthopaedic surgery: a qualitative study of the experiences of people with inflammatory arthritis taking part in the Periscope trial

Abstract

Biologic Disease Modifying Anti-Rheumatic Drugs (BDMARDs) are effective in reducing symptoms of inflammatory arthritis and slowing disease progression. Current guidelines recommend pausing these for surgery, but evidence about benefits, risks and experiences of stopping or continuing BDMARDs during the perioperative period is limited. This qualitative study explores the experiences and perspectives of those taking part in a randomised controlled trial comparing the outcomes for adults with inflammatory arthritis who continue or pause BDMARDs in the perioperative period for orthopaedic surgery (the PERISCOPE study). Thematic analysis of qualitative semi-structured interviews (conducted 2023-24; in person, by phone or video call) with 26 adults (age 18+) with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis living in the UK, and participating in PERISCOPE. In the sample, 11 continued biologics and 15 stopped them prior to surgery. A central theme ‘the need for surgery overshadows the benefits and risks of stopping or continuing biologics’, and two sub-themes ‘living with arthritis involves accepting risk and uncertainty’ and ‘biologics (the term most used by participants for BDMARDs) are potentially life-changing, and people worry about them not working’ were developed. Many participants described an ongoing and sometimes trial-and-error approach to treatment, and an acceptance of treatment uncertainty and risks as the disease progressed and needs changed over time. The pain and loss of function when requiring surgery sometimes meant that associated risks, including those related to continuing or stopping biologics were accepted or overshadowed, even for participants who described life-changing benefits and expressed a preference to continue biologics. Many of these participants described worrying about pausing biologics in case they stopped working or caused a flare or further damage to joints when paused. The consequences of pausing biologics for surgery is a key concern for people living with inflammatory arthritis. However, the need for surgery and an acceptance of uncertainty and risk can mean that treatment preferences and concerns about risks are not always given full consideration. This has implications for decision-making should people be offered the choice to continue or pause biologics for surgical procedures. ISRCTN17691638 (http://www.isrctn.org/). People with inflammatory arthritis experience a trial-and-error approach to treatment and learn to accept treatment uncertainty and risks. Biologics can be life-changing, and people worry about pausing or changing these, or what happens next if medication stops working. The need for surgery can overshadow associated risks, including those related to stopping or continuing biologics in the perioperative phase.

The authors' abstract, as published at the source. BMC Rheumatology, 2026 · DOI ↗