Perioperative Treatment of Patients with Rheumatoid Arthritis

Abstract

Rheumatoid arthritis is an autoimmune disease mediated by a widespread chronic systematic inflammatory process that causes joint deterioration, which leads to pain, disability, and poor quality of life. The increased use of disease-modifying antirheumatic drugs has been shown to markedly slow disease progression, which has translated into a decrease in the need for orthopaedic intervention in this population. However, a substantial percentage of patients with the disease fail optimal pharmacologic treatment and still require surgical intervention. A thorough understanding of medical considerations in these patients and improved knowledge of the medical complications caused by the disease process and the pharmacologic therapy used to treat it may lead to improved preoperative planning and medical clearance, which may ultimately improve the overall postoperative outcome.

Utility of 18fdg‐pet Imaging in the Diagnosis of Diffuse Large Vessel Giant Cell Arteritis

“…Conclusion: Histiocyte Society has its diagnostic criteria which includes fever for seven days or more with temperature of 38.5 C, splenomegaly, pancytopenia, hypofibrinogenemia or hypertriglyceridemia, haemophagocytosis in bone marrow, in lymph node or spleen, rashes. Five of these must be met to diagnose the condition 3 . Patient passed away due to HLH syndrome with uncertain or possible multiple secondary causes which are difficult to identify and treat.…”

Perioperative Management of Rheumatoid Medications in Orthopedic Surgery

“…Nonsteroidal anti-inflammatory drugs remain the first-line treatment for pain and stiffness in patients with RA. 2 Aspirin and nonsteroidal anti-inflammatory drugs inhibit the action of the cyclooxygenase (COX) family of enzymes, thereby decreasing the synthesis of prostaglandins and exerting an anti-inflammatory effect on the body. However, another consequence of their action is an increased risk of bleeding secondary to their anticoagu-lative effect.…”

“…In particular, patients with RA have several extra-articular manifestations, including interstitial lung disease, cardiovascular disease, rheumatoid nodules, cervical spine disease, and decreased immunity. 2 To slow the progression of this insidious disease, prompt therapy is essential. Orthopedists must understand the complexities of these treatments because 58% of patients with RA will ultimately undergo orthopedic surgery, with nearly 24% undergoing large-joint arthroplasty (Table).…”

“…However, in suppressing the body's natural immune response, these medications can increase the risk of infection and decrease the potential for wound healing, which can lead to unsuccessful outcomes in the postoperative period. 2 Although a seemingly natural response to this conundrum would be to simply discontinue these medications prior to surgery, doing so is not without significant risk of a rheumatoid flare. Thus, a careful, balanced approach is needed prior to planning a surgical intervention for a patient with RA.…”

Total knee arthroplasty in patients with rheumatoid arthritis-midterm results

“…In terms of complication rate of total knee arthroplasty in patients with RA, there are several studies that indicate the existence of a higher complication rate compared to TKA in primary knee arthrosis 14,15 , as well as others which do not mention a greater complication rate 6,16 . There are many rea- sons why patients with RA, compared to those with OA, may be at greater risk of early complications after total knee arthroplasty.…”