What is the perioperative medication management of rheumatic diseases?

Updated: Jan 09, 2018
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: William A Schwer, MD  more...
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Whether perioperative methotrexate increases the risk of postoperative complications (eg, infections, poor wound healing) remains unclear. Because the drug is predominantly cleared from the body by the kidneys, withholding the drug 48 hours before surgery or any other procedure (eg, contrast dye study) that may be associated with even transient renal insufficiency is prudent. Some surgeons also prefer to withhold the drug for 2 weeks postoperatively to ensure appropriate wound healing.

Similarly, withholding cyclophosphamide (also excreted renally) a few days prior to surgery is recommended. Other antirheumatic drugs (eg, hydroxychloroquine, colchicine, gold, sulfasalazine, azathioprine) should be discontinued prior to surgery, although very little data exist regarding their use in the perioperative period.

Depending on the severity of the rheumatologic condition, methotrexate should be started as soon as possible after surgery to avoid a rebound flare in arthritis. Discuss restarting all antirheumatic medications with the patient's rheumatologist.

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