This 2006 narrative review addresses how to manage NSAIDs, corticosteroids, methotrexate, and biologic DMARDs in RA patients undergoing orthopedic surgery — asking which drugs to hold, continue, or dose-adjust, and for how long, to minimize infection and wound healing complications without triggering disease flares.
When an RA patient is on your OR schedule, check their DMARD regimen early: continue methotrexate, hydroxychloroquine, and sulfasalazine through surgery; hold TNF inhibitors for moderate-to-intensive cases and restart at 10–14 days postop; and dose corticosteroid supplementation to the stress tier of the procedure rather than reflexively giving high-dose stress steroids.
This 2006 narrative review addresses how to manage NSAIDs, corticosteroids, methotrexate, and biologic DMARDs in RA patients undergoing orthopedic surgery — asking which drugs to hold, continue, or dose-adjust, and for how long, to minimize infection and wound healing complications without triggering disease flares.
When an RA patient is on your OR schedule, check their DMARD regimen early: continue methotrexate, hydroxychloroquine, and sulfasalazine through surgery; hold TNF inhibitors for moderate-to-intensive cases and restart at 10–14 days postop; and dose corticosteroid supplementation to the stress tier of the procedure rather than reflexively giving high-dose stress steroids.