Biologic Therapy Is Associated with Faster Bone Union After the Sauvé–Kapandji Procedure in Patients with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is characterized by chronic inflammation and impaired bone quantity and quality, which may delay postoperative bone healing. The Sauvé–Kapandji (SK) procedure is a common surgical strategy for distal radioulnar joint disorders, but the association between RA medications—particularly biologic and targeted synthetic disease-modifying antirheumatic drugs (b/ts DMARDs)—and bone union after SK is unclear. This study aimed to identify patient- and treatment-related factors associated with bone union time, with a special focus on biologic therapy. We retrospectively analyzed patients with RA who underwent SK. Bone union was assessed using serial wrist radiographs, and union timing was independently evaluated by multiple orthopedic specialists in a blinded manner. Patient characteristics—including demographics, disease activity, medication use, bone mineral density, and biomarkers—were analyzed. Correlations with bone union duration were examined using Pearson’s test; intergroup comparisons used t tests, Fisher’s exact test, or Wilcoxon tests. Multiple regression identified independent predictors of union time. All patients achieved bone union. Higher matrix metalloproteinase-3 levels and methotrexate (MTX) dose were associated with prolonged healing, whereas biologic agents, specifically tumor necrosis factor (TNF) inhibitors, were associated with significantly shorter union time. Nonsteroidal anti-inflammatory drugs (NSAIDs) use was also linked to delayed healing. Multivariate analysis confirmed that MTX dose, biologic use, and NSAIDs use were independently associated with bone union duration. Biologic therapy was independently associated with faster bone union after SK, whereas higher MTX dosage and NSAIDs use were linked to delayed healing. In current clinical practice, biologic agents are often withheld during the perioperative period because of concerns regarding wound healing; however, our findings suggest that, from the standpoint of bone union, biologic therapy may have a favorable effect. Larger prospective studies are warranted to confirm these findings and clarify the optimal perioperative management of b/ts DMARDs in this setting. Patients with rheumatoid arthritis often have reduced bone strength and may heal more slowly after surgery because of chronic inflammation and medications. The Sauvé–Kapandji procedure is commonly used to relieve pain and improve forearm rotation when the distal radioulnar joint is destroyed. We reviewed patients with rheumatoid arthritis who underwent this procedure at our hospital and measured the time to complete bone union on serial wrist radiographs, assessed independently by five blinded specialists. All patients achieved bone union. Shorter healing time was observed in patients treated with TNF inhibitor biologic therapy, whereas higher methotrexate dose and use of nonsteroidal anti-inflammatory drugs were associated with longer healing time. Prednisolone dose showed no meaningful association with healing time in this cohort. Because this was a small retrospective study, the results should be interpreted as associations and need confirmation in larger prospective studies.