Perioperative Management of Medications Used in the Treatment of Rheumatoid Arthritis


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.

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The authors would like to thank C. Ronald MacKenzie, MD, for his editorial assistance in preparation of this manuscript.

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Corresponding author

Correspondence to Carla R. Scanzello MD, PhD.

Additional information

Supported by the Hospital for Special Surgery Frankenthaler Fellowship in Restorative Mobility (C.R. Scanzello).

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Scanzello, C.R., Figgie, M.P., Nestor, B.J. et al. Perioperative Management of Medications Used in the Treatment of Rheumatoid Arthritis. HSS Jrnl 2, 141–147 (2006).

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Key words

  • Rheumatoid arthritis
  • perioperative management
  • corticosteroids
  • methotrexate
  • anti-TNF
  • rituximab