Biologic medications treat autoimmune conditions like rheumatoid arthritis, psoriasis, inflammatory bowel disease, and others by targeting specific parts of the immune system. Their effects on immunity require careful timing around surgery. Knowing how biologics are managed helps you coordinate care between your surgeon and prescribing specialist.
What Biologic Medications Are
Biologics are medications made from living cells rather than synthesized chemically. They work by targeting specific proteins involved in inflammation and immune activity.
Common biologics include TNF inhibitors (adalimumab, etanercept, infliximab), IL-6 inhibitors (tocilizumab), IL-17 inhibitors (secukinumab), IL-23 inhibitors (ustekinumab, risankizumab), B-cell depleting agents (rituximab), and T-cell inhibitors (abatacept).
Because biologics suppress parts of the immune system to reduce inflammation, they can impair the body's ability to fight infection after surgery.
Biologics are used for rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriasis, and other autoimmune conditions.
The dosing schedule for most biologics is weekly, biweekly, or monthly, which affects how timing around surgery is planned.
Why Biologics Are Paused Before Surgery
Biologics suppress immune function. Ongoing immunosuppression at the time of surgery increases the risk of postoperative wound infection, surgical site infection, and delayed healing.
The American College of Rheumatology (ACR) recommends withholding most biologic medications before elective surgery. The timing depends on the specific drug and its half-life (how long it stays active in your body).
General guidance from the ACR: withhold most biologics for one dosing cycle before elective surgery. For example, if your injection is weekly, skip one dose before the procedure.
Rituximab has a very long effect duration (6 to 12 months). Surgery is typically planned at least 6 months after a rituximab infusion when possible.
Emergency surgery cannot always wait for biologics to clear. Your surgical team will weigh the risks and benefits based on urgency.
Stopping a biologic may cause flares of your underlying condition. Discuss this risk with your prescribing specialist well before your surgery date.
Restarting After Surgery
The ACR recommends waiting until the surgical wound shows adequate healing before restarting biologics. This is typically 14 days after surgery for most procedures without complications.
If your wound is not healing well or you have an active infection, biologics should not be restarted until the infection is resolved.
Your rheumatologist or prescribing specialist, together with your surgeon, should coordinate the decision to restart.
Restarting too early can increase infection risk. Waiting too long risks disease flares. Communication between specialists is critical.
Document the pause in your medical records and with your pharmacist to ensure your prescription refill schedule is adjusted accordingly.
Coordinating Care Between Specialists
Notify both your surgeon and your prescribing specialist (rheumatologist, gastroenterologist, dermatologist) as soon as surgery is scheduled.
Bring a complete list of your biologics, dosing schedule, and your specialty provider's contact information to your pre-operative appointment.
Ask your specialist to send a note to your surgical team outlining the biologic management plan, including which dose to skip and when to restart.
If your disease flares after stopping your biologic, contact your specialist. Flares can sometimes be managed with short-term corticosteroids or disease-modifying drugs while you wait for the surgical wound to heal.
Frequently asked
Questions patients ask.
Do I need to stop my biologic before all surgeries?
The recommendation to pause applies mainly to elective (planned, non-emergency) surgeries. For most elective procedures, one dosing cycle is withheld before surgery. For minor procedures like dental work, many specialists do not recommend stopping biologics. Always confirm with your prescribing specialist and surgeon.
Will stopping my biologic cause a flare?
It may. Some patients experience increased joint pain, skin disease, or gut symptoms when a biologic is withheld. Short-term bridge therapy with corticosteroids or disease-modifying antirheumatic drugs (DMARDs) is sometimes used during this window to manage disease activity. Discuss this proactively with your specialist.
How long does it take for a biologic to leave my system?
This varies by drug. Most TNF inhibitors are cleared after one to two dosing cycles. Rituximab is unusual because it depletes B cells for 6 to 12 months regardless of when the last dose was given. Your prescribing specialist can tell you the washout period for your specific medication.
What if I forget to tell my surgeon about my biologic?
Contact your surgeon's office as soon as possible before your procedure. Your surgical team needs this information to plan your perioperative care, assess infection risk, and coordinate with your specialist. It is never too late to share this information before the day of surgery.
For patients
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This guide provides general information. For instructions tailored to your specific procedure, ask your provider about QR Rx care plans.
These medication guides are for educational purposes only and do not replace medical advice. Always follow your healthcare provider's specific medication instructions.
