HSS Journal

, Volume 2, Issue 2, pp 141-147

First online:

Perioperative Management of Medications Used in the Treatment of Rheumatoid Arthritis

  • Carla R. ScanzelloAffiliated withDepartment of Rheumatology, Hospital for Special Surgery Email author 
  • , Mark P. FiggieAffiliated withDepartment of Orthopedic Surgery, Hospital for Special Surgery
  • , Bryan J. NestorAffiliated withDepartment of Orthopedic Surgery, Hospital for Special Surgery
  • , Susan M. GoodmanAffiliated withDepartment of Rheumatology, Hospital for Special Surgery

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Patients with rheumatoid arthritis (RA), an inflammatory arthritis that can destroy joint structures, are often on multiple medications to control disease activity. These medications may have significant toxicities and side effects. Over the course of their lifetime, patients with this disease often require orthopedic procedures, including total joint arthroplasty, and the medications they are taking present management issues specific to the perioperative period. As many of these medications are immunosuppressive, the concern for postoperative infection and delayed wound healing are particularly worrisome. We conducted a review of the available literature pertaining to the perioperative use of the most commonly prescribed medications for RA. Although the existing data directly addressing perioperative complications in orthopedic surgery is sparse, information on relevant complications resulting from the general use of these drugs may be used as a basis for conservative recommendations.

Key words

Rheumatoid arthritis perioperative management corticosteroids methotrexate anti-TNF rituximab