People with inflammatory arthritis who faced orthopaedic surgery often put concerns about pausing their biologic medications aside, according to a qualitative study published in BMC Rheumatology on 24 October 2026. The research drew on interviews with adults taking part in the PERISCOPE randomised controlled trial, which is comparing outcomes for people who either continue or pause biologic disease modifying anti-rheumatic drugs, or BDMARDs, around the time of surgery.
Interviews took place in person, by phone or by video call with 26 adults aged 18 or over living in the UK. All participants had rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis and were taking part in PERISCOPE. Within the sample, 11 participants continued their biologics before surgery and 15 stopped them.
BDMARDs are effective at reducing symptoms of inflammatory arthritis and slowing disease progression. Current guidelines recommend pausing these drugs for surgery, but the authors note that evidence about the benefits, risks and experiences of stopping or continuing BDMARDs during the perioperative period is limited. The PERISCOPE trial, registered under ISRCTN17691638, was designed to compare outcomes between the two approaches, and this qualitative study explored the perspectives of the people living through those decisions.
The analysis produced one central theme, described as ‘the need for surgery overshadows the benefits and risks of stopping or continuing biologics’, along with two sub-themes: ‘living with arthritis involves accepting risk and uncertainty’ and ‘biologics are potentially life-changing, and people worry about them not working’. The researchers report that ‘biologics’ was the term most commonly used by participants when referring to BDMARDs.
Many participants described an ongoing, sometimes trial-and-error approach to managing their treatment, and said they had come to accept uncertainty and risk as their disease progressed and their needs changed over time.
The pain and loss of function that led people to need surgery sometimes meant that associated risks, including those related to continuing or stopping biologics, were accepted or overshadowed. This was true even for participants who described life-changing benefits from their biologics and expressed a clear preference to continue taking them through surgery.
Worry about pausing treatment was a recurring concern. Many participants who valued their biologics highly described fearing that pausing them before surgery could cause the drugs to stop working, trigger a disease flare, or allow further damage to their joints.
The authors conclude that the consequences of pausing biologics for surgery are a key concern for people living with inflammatory arthritis. However, they report that the need for surgery, together with an acceptance of uncertainty and risk, can mean that treatment preferences and concerns about risks are not always given full consideration. They state that this has implications for decision-making should people be offered the choice to continue or pause biologics for surgical procedures.
The study’s key messages underline three points drawn from the interviews: 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 them, or about what happens next if medication stops working; and the need for surgery can overshadow associated risks, including those related to stopping or continuing biologics in the perioperative phase.
As a qualitative interview study of 26 UK-based PERISCOPE participants, the findings describe the experiences and perspectives of this specific group rather than measuring clinical outcomes, and the trial itself continues to compare perioperative outcomes between those who continue and those who pause their biologics. The article was published as open access research, and the version shared on 24 October 2026 is an accepted manuscript that remains subject to further edits before the final version of record.
Subject of Research: Experiences of people with inflammatory arthritis deciding whether to stop or continue biologic drugs before orthopaedic surgery
Article Title: Stopping or continuing biologics before orthopaedic surgery: a qualitative study of the experiences of people with inflammatory arthritis taking part in the Periscope trial
Article References: Taylor, J., Brady, S., Abramson, K. D., Carlisle, K., Hartley, B., Lowdon, T., Mankia, K., Mott, A., Pandit, H., & Adamson, J. (2026). Stopping or continuing biologics before orthopaedic surgery: a qualitative study of the experiences of people with inflammatory arthritis taking part in the Periscope trial. BMC Rheumatology. https://doi.org/10.1186/s41927-026-00706-z
Image Credits: AI Generated
DOI: 10.1186/s41927-026-00706-z
Keywords: inflammatory arthritis, biologics, BDMARDs, orthopaedic surgery, perioperative care, PERISCOPE trial, qualitative research, rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, shared decision-making, BMC Rheumatology
News Source: Ophelia Keating. (October 27, 2026). Surgery needs can overshadow biologic pause worries, arthritis trial interviews find. Scienmag.
