Here is a list of the general classes of medications physicians utilize to treat RA.5Given the increased incidence of infection associated with the utilization of disease-modifying medications (secondary to their immunosuppressive effects), researchers initially suggested discontinuing these medications in the perioperative period due to the potential of an increased incidence of perioperative sepsis. Close communication between surgeons, anesthesiologists, and rheumatologists is critical to provide the best care for these patients.Patients with RA suffer higher rates of infection at baseline compared to other patients without RARetrospective review of hand surgery in patients who continued on their routine treatment for RA including methotrexate, with median weekly dose of 10 mg, did not demonstrate an increased risk of infectionA prospective evaluation of 201 patients (94% of whom had RA) were enrolled to an open label study in which they continued their stable therapy of methotrexate, leflunomide, or anti-tumor necrosis factor-α (TNF-α) therapy during the perioperative time period. The highest risk for perioperative infection in this study was previous surgical site infectionIn a retrospective cohort of 16 patients all of whom were treated with TNF-α inhibitor therapy, there were no perioperative infections either in the group who continued the therapy or those who discontinued. Examples of minor surgical stress include dental procedures, colonoscopy, and inguinal hernia repair. eloza.hcsc@salud.madrid.org
Complete views were only performed in 5% of patients. Further, there must be close communication with anesthesiologists in terms of airway management particularly in light of the risk for cervical spine disease. For example, piroxicam (Feldene, Pfizer) or oxaprozin (Daypro, Pfizer) may require discontinuation up to 10 days prior to surgery whereas intermediate acting medications such as nabumetone (Relafen, GlaxoSmithKline) may require discontinuation five days prior to surgery. In that case, the plain radiographs identified posterior subluxation, but spinal cord impingement was only identified on CTThere are currently no guidelines regarding radiographic imaging in patients pursuing surgery. For further reading, see “Treating Severe Deformity In Young Patients With Rheumatoid Arthritis” in the September 2003 issue of Podiatry Today, “What You Should Know About New Antirheumatic Medications” in the April 2005 issue or “Lower Extremity RA: Can Orthoses Have An Impact?” in the April 2006 issue. The study authors did not find methotrexate to be associated with any increased risk of complications. Overall, individuals with rheumatoid arthritis have a higher risk of myocardial infarction which is similar to individuals with diabetes mellitus or a person 10 years older than the age of the patientAs part of the American College of Cardiology/American Heart Association (ACC/AHA) perioperative guidelines, in the setting of emergent surgery, no additional cardiac evaluation is recommended. The study authors recommended interruption of perioperative leflunomide to avoid increased complication rates. Some DMARDs such as methotrexate and hydroxychloroquine appear safe in the perioperative period. Eric L Matteson, MD, MPH, Professor, Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. There is an increased risk of excessive postoperative hemorrhage in patients who fail to discontinue aspirin therapy prior to surgery. However, history and exam alone cannot be relied upon to identify cervical spine disease. 4. Different risk calculators have been generated to predict perioperative cardiovascular risk.