Preoperative evaluation and perioperative management of patients with rheumatic diseases
- John S Axford, DSc, MD, FRCP, FRCPCH
John S Axford, DSc, MD, FRCP, FRCPCH
- Section Editor — Scleroderma
- Emeritus Professor of Rheumatology
- St George's University of London
- Section Editors
- Robert H Shmerling, MD
Robert H Shmerling, MD
- Section Editor — Diagnostic Issues in Rheumatology
- Associate Professor of Medicine
- Harvard Medical School
- Stephanie B Jones, MD
Stephanie B Jones, MD
- Editor-in-Chief — Anesthesiology
- Section Editor — Anesthesia with Comorbid Non-Cardiopulmonary Conditions
- Associate Professor of Anesthesia
- Harvard Medical School
There is a spectrum of rheumatic diseases that affect patients of all ages . Thus, clinicians working with patients with musculoskeletal disorders must be aware that there are general and specific issues involved in their pre- and postoperative 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".)
PREOPERATIVE EVALUATION AND 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 .
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- PREOPERATIVE EVALUATION AND MANAGEMENT
- History and physical examination
- Laboratory testing
- GENERAL MANAGEMENT ISSUES
- Medication management
- - Glucocorticoids
- - Nonsteroidal antiinflammatory drugs
- - Methotrexate and other nonbiologic DMARDs
- - Biological agents
- DISEASE SPECIFIC ISSUES
- Sjögren's syndrome
- Rheumatoid arthritis
- Juvenile idiopathic arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Hemophiliac arthropathy
- Systemic lupus erythematosus
- Progressive systemic sclerosis (scleroderma)
- SUMMARY AND RECOMMENDATIONS