Rheumatological considerations in the qualification of rheumatoid patients for surgical treatment and principles for pre- and post-operative management.
The surgical treatment of rheumatoid arthritis patients can be safe because it is planned treatment, but it requires the close cooperation of the orthopedic surgeon, the rheumatologist, and the anesthesiologist. The proper evaluation of the risk factors for coexisting diseases decreases the possibility of general surgical and infectious complications. Thromboembolic preventive measures after surgery are an absolute requirement, for at least 15 days after the operation, using heparin of low molecular weight; preventive antibiotic therapy is also required, using second-generation cephalosporing for 3-5 days, depending on the risk factors. Methotrexate treatment should be suspended for 7 days during the peri-operative period. Prolonged steroid therapy creates a risk of adrenal failure in the event of illness or peri-operative stress, which increases with the steroid dosage and the prolongation of therapy. Steroid administration cannot be stopped prior to surgery. Treatment outcome depends on the activity level the disease and the skill of the surgeon, as well as pre- and post-operative care and rehabilitation.
Radzikowska
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Klinika Reumoortopedii, Instytut Reumatologiczny, Warszawa.