Perioperative Medication Management in the Rheumatic Diseases

Excerpt

Despite major advances in therapy, patients with chronic rheumatic diseases continue to require surgery to address pain and functional incapacity [1‐3]. Most often of an orthopedic nature, particularly total joint arthroplasty, rheumatologists and increasingly specialists in hospital-based medicine are asked to evaluate and care for such patients in the perioperative setting. As modern day rheumatic disease therapy is a complex and rapidly evolving domain, perioperative management in this clinical context may seem challenging particularly to physicians less familiar with these therapies. This commentary presents a succinct summary of the relevant pharmacological considerations emphasizing the results of a recently published collaboration of American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) from which evidence-based guidelines for the perioperative management of anti-rheumatic drug therapy have been developed [4]. Owing to their anti-inflammatory and immunosuppressive nature, concerns regarding the risk of postoperative infection as well as impaired wound healing have long encircled the use of these medications in the surgical setting. Given the high prevalence of their usage, decision-making is a frequently encountered conundrum and one that provides an opportunity for the mitigation of important postoperative risks. …