Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery

J Perioper Pract. 2020 Sep;30(9):265-270. doi: 10.1177/1750458919886186. Epub 2019 Nov 7.

Abstract

Rheumatoid arthritis is an autoimmune disease which is characterised by systemic inflammation. In the recent decades, the advent of disease modifying anti-rheumatic drugs have reduced the need for orthopaedic procedures. However, there are numerous patients in which pharmacological treatment fails and these patients require surgical intervention. Complications can arise due to the underlying pathology and multitude of medications these patients can be on, specifically increased infection rates due to use of immunosuppressive agents. An understanding into the disease itself, as well as perioperative management, may improve overall patient outcomes and prevent future complications.

Keywords: Anti-rheumatic disease modifying drugs; Biologics; Glucocorticoids; Perioperative management; Rheumatoid arthritis; Surgical site infection; Trauma and orthopaedic surgery.

MeSH terms

  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / surgery*
  • Arthroplasty, Replacement, Hip / adverse effects
  • Arthroplasty, Replacement, Knee / adverse effects
  • Biomarkers / metabolism
  • Disease Progression
  • Humans
  • Orthopedic Procedures / methods*
  • Postoperative Complications
  • Surgical Wound Infection / prevention & control

Substances

  • Antirheumatic Agents
  • Biomarkers