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Preoperative evaluation and perioperative management of patients with rheumatic diseases

John S Axford, DSc, MD, FRCP, FRCPCH
Section Editors
Robert H Shmerling, MD
Stephanie B Jones, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


There is a spectrum of rheumatic diseases that affect patients of all ages [1]. Thus, clinicians working with patients with musculoskeletal disorders must be aware that there are general and specific issues involved in their pre- and post-operative management [2,3].

Areas of special concern for patients with rheumatic diseases who are having surgery will be discussed here. General issues in preoperative medical consultation and perioperative management are presented separately. (See "Preoperative medical evaluation of the adult healthy patient" and "Evaluation of cardiac risk prior to noncardiac surgery" and "Prevention of venous thromboembolic disease in surgical patients" and "Perioperative medication management".)


A thorough history, physical examination, targeted laboratory studies, and specific imaging procedures are recommended.

History and physical examination — All patients require a careful history and physical examination, with further evaluation indicated in some individuals. As examples:

Rheumatoid arthritis (RA) is associated with a 60 percent increase in risk of cardiovascular death compared with the general population [4].


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Literature review current through: Sep 2016. | This topic last updated: Nov 25, 2014.
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