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Perioperative Medication Management for the Patient With Rheumatoid Arthritis

Dr. Howe is Resident, Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, WA. Dr. Gardner is Professor, Division of Rheumatology, and Adjunct Professor, Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Washington School of Medicine. Dr. Kadel is Associate Professor, Department of Orthopaedic Surgery, University of Washington School of Medicine.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Howe and Dr. Kadel. Dr. Gardner has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Amgen and Abbott Laboratories.

Reprint requests: Dr. Howe, Department of Orthopaedic Surgery, Box 356500, University of Washington, Seattle, WA 98195.

The treatment of rheumatoid arthritis has improved dramatically in recent years with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thus requiring surgical intervention to reduce pain and improve function. In these cases, the orthopaedic surgeon frequently encounters patients on a drug regimen consisting of nonsteroidal anti-inflammatory drugs, glucocorticoids, methotrexate, and biologic agents (disease-modifying antirheumatic drugs). Consultation with a rheumatologist is recommended, but the surgeon also should be aware of these medications that could potentially affect surgical outcome. Prudent perioperative management of these drugs is required to optimize surgical outcome. A balance must be struck between minimizing potential surgical complications and maintaining disease control to facilitate postoperative rehabilitation of patients with rheumatoid arthritis.

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