title: The place of methotrexate perioperatively in elective orthopedic surgeries in patients with rheumatoid arthritis.
abstract: No clear consensus exists on whether methotrexate (MTX) should be continued or whether this therapy should be discontinued for a few weeks in patients with rheumatoid arthritis (RA) undergoing surgery. Continued MTX therapy may impair wound healing, but discontinuation of the therapy may increase the risk of flares. In this article we review published data on the perioperative management of MTX in patients with RA undergoing elective orthopedic surgery. Eight papers on this topic could be identified. These studies compare continued vs. discontinued MTX therapy or MTX therapy vs. therapies other than MTX. Summing up the published data, continued MTX therapy appears to be safe perioperatively and seems also to be associated with a reduced risk of flares. None of the examined papers addresses the issue of safety in connection with comorbidities, age or high doses of MTX.
authors.affiliation: Section of Rheumatology, 2nd Department of Medicine, General Hospital Linz, Krankenhausstr. 9, Linz, 4020, Austria. herwigpi@yahoo.com
authors.forename: Herwig
authors.initials: H
authors.lastname: Pieringer
authors.forename: Ulrike
authors.initials: U
authors.lastname: Stuby
authors.forename: Georg
authors.initials: G
authors.lastname: Biesenbach
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000601:surgery*; D001178:Arthroplasty; D017558:Elective Surgical Procedures; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D019990:Perioperative Care; D014945:Wound Healing
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate