Rheumatoid arthritis, medications and surgery
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