Patients with rheumatoid arthritis (RA) who are having a joint replacement are more likely to face an infection risk from glucocorticoids than from a biologic they may be prescribed, a US study suggests.

Researchers analysed retrospective data on nearly 11,000 procedures in adults with RA having elective total knee or hip arthroplasty, either primary or revision, and who had recently received abatacept, adalimumab, etanercept, infliximab, rituximab or tocilizumab before surgery.

Outcomes were hospitalised infection within 30 days of the procedure and prosthetic joint infection within a year after surgery compared between biologics and with different doses of glucocorticoids, the authors wrote in Annals of Internal Medicine.

In addition to long-term therapy with a biologic, 43% received glucocorticoids and 46% received methotrexate within 90 days before surgery.