We recommend that adults and children over 12 wear face masks when attending our clinic, but no longer provide masks to patients and carers. Videoconsultations are conducted via telehealth at our dedicated virtual clinic. We are experiencing high demand for appointments hence require that all patients provide a referral prior to booking an appointment so that we can identify and manage urgent and emergency conditions in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation. If our surgeons assess that your condition (especially recent injuries) is best managed with hand therapy rather than surgery we may recommend that you see a qualified hand therapist (physiotherapist or occupational therapist) rather than schedule an appointment with our surgeons. Dr Tomlinson does not offer consultations and surgical services where a Medicare Rebatable Item Code does not apply; this includes injections for palmar hyperhidrosis. Dr Tomlinson has scheduled sabbatical leave during much of October, November and December 2023 so will not be available for urgent or emergency referrals during that time.

Rheumatoid arthritis, medications and surgery

Created 22 August 2012, last modified 15 February 2016

capsules 200x150 Decisions to stop or continue medications before or after surgery need to take into consideration your medical conditions as well as the type of surgery. For minor procedures that are performed under local anaesthetic there is usually no need to stop regular medications for rheumatoid arthritis, but for larger procedures it may be recommended to stop the medication prior to surgery and recommence it once your wounds have healed (usually 2 weeks after surgery). Current evidence suggests:

Medication	Perioperative management
NSAIDs	Continue for hand surgery unless unusually high bleeding risk exists
Methotrexate	Continue
Sulfasalazine	Insufficient data
Azathioprine	Insufficient data
Cyclophosphamide	Insufficient data
Cyclosporine	Discontinue 3-4 days before surgery, recommence after wounds have healed
Hydroxychloroquine	Discontinue prior to surgery; recommence after wounds have healed
Penicillamine	Discontinue on day of surgery, recommence after wounds have healed
Leflunomide®	Insufficient data
Infliximab®	Insufficient data
Etanercept®	Insufficient data
Adalimumab®	Insufficient data
Hydrocortisone	Continue
Prednisolone	Continue
Methylprednisolone	Continue
Dexamethasone	Continue

Reference

Thorsness RJ, Hammert WC. Perioperative management of rheumatoid medications. J Hand Surg AM 2012; 37A; p1928-1931

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