My colleague Greg Gardner has put together a very nice summary of these concerns in this article published in the AAOS journal. Quoting from this article "Managing the perioperative drug regimen of the patient with RA can be challenging, but it is essential in order to optimize surgical outcome.
Perioperative consultation and collaboration with the patient’s rheumatologist or internist is recommended. In patients with RA, correct timing of discontinuation of NSAIDs in preparation for surgery may avoid patient discomfort without risking complications resulting from cyclooxygenase inhibition. Corticosteroid management depends on the type of orthopaedic procedure and must be part of perioperative planning. The goal of perioperative management of DMARDs is to reduce the risk of infection and optimize wound healing while minimizing the chance of a disease flare that could compromise recovery. Currently,methotrexate is the only medication with evidencebased data supporting continuing treatment through surgery.Without data to the contrary, we recommend that the more powerful biologic agents should be used as described in Table 1. These recommendations may change as experience and data accumulate"
The tables from this article are shown below
See also Medicines to Avoid Before Surgery
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