Perioperative Management of Medications Used in the Treatment of Rheumatoid Arthritis

HSS Journal

Susan M. Goodman, MD
Susan M. Goodman, MD
Associate Attending Physician, Hospital for Special Surgery
Associate Professor of Medicine, Weill Cornell Medical College
Mark P. Figgie, MD
Mark P. Figgie, MD

Chief of the Surgical Arthritis Service, Hospital for Special Surgery
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery

Bryan J. Nestor, MD
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor in Orthopaedic Surgery, Weill Cornell Medical College

Carla R. Scanzello, MD
Department of Rheumatology
Hospital for Special Surgery

Patients with rheumatoid arthritis (RA), an inflammatory arthritis that can destroy joint structures, are often on multiple medications to control disease activity. These medications may have significant toxicities and side effects. Over the course of their lifetime, patients with this disease often require orthopedic procedures, including total joint arthroplasty, and the medications they are taking present management issues specific to the perioperative period. As many of these medications are immunosuppressive, the concern for postoperative infection and delayed wound healing are particularly worrisome. We conducted a review of the available literature pertaining to the perioperative use of the most commonly prescribed medications for RA. Although the existing data directly addressing perioperative complications in orthopedic surgery is sparse, information on relevant complications resulting from the general use of these drugs may be used as a basis for conservative recommendations.

This article appears in HSS Journal: Volume 2, Number 2.
View the full article at

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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