JRPMS Vol 3, No 2, June 2019, p.71-77
Perioperative medication management of patiens with Rheumatoid Arthritis
- Rheumatology Dept., KAT General Hospital of Athens, Greece
Keywords: Rheumatoid Arthritis, Perioperative management, DMARDs, TNFα, Glucocorticoids
Rheumatoid Arthritis (RA) is a chronic, systemic, inflammatory disease that is characterised by inflammation of the synovial membrane and progressive destruction of articular cartilage and bone. Furthermore, RA is often associated with extra-articular manifestations. A multidisciplinary approach is required for patients with RA in the peri-operative period. This review discusses the pre-operative, peri-operative and post-operative management of patients with RA and attempts to provide plausible answers to challenging questions that arise often when patients with RA undergo surgery. The key issues a physician has to address include controlling disease activity, assisting the wound-healing process by eliminating any delaying factors related to RA and preventing post-operative complications that may occur. The peri-operative care of patients with RA must be (strictly) personalised, given that it has to take into account a wide set of factors such as the type of surgery and the anaesthesia needed, the disease activity, the current medication the patient receives and the risk factors of co-morbidity such as age, smoking and decreased cardiac, renal, pulmonary or peripheral vascular function.