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
Clinicians caring for patients with rheumatic diseases must be aware that there are specific issues involved in their pre- and postoperative management [1,2].
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".)
History and physical examination — All patients require a careful preoperative history and physical examination, with further evaluation indicated in some individuals. Some particular concerns among patients with rheumatic diseases include the following:
●Many rheumatic diseases are associated with increased risks of coronary artery disease, arrhythmias, heart failure, or cardiac death. (See "Overview of the systemic and nonarticular manifestations of rheumatoid arthritis", section on 'Cardiac disease'.)
Determining cardiovascular risk may be more difficult because many patients with rheumatic diseases are not physically active. An exercise or pharmacologic stress test may be necessary in some circumstances to adequately assess the risk of perioperative myocardial infarction. (See "Evaluation of cardiac risk prior to noncardiac surgery".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PREOPERATIVE EVALUATION
- History and physical examination
- Laboratory testing
- GENERAL MANAGEMENT PRINCIPLES
- Assessment of disease activity
- Cardiac risk assessment
- Management of thrombophilia in antiphospholipid syndrome
- Medication management
- - Glucocorticoids
- - Nonsteroidal antiinflammatory drugs
- - Nonbiologic DMARDs
- - Biologic DMARDs
- - Antirheumatic kinase inhibitor
- - Other SLE-specific medications
- DISEASE-SPECIFIC ISSUES
- Sjögren's syndrome
- Rheumatoid arthritis
- Juvenile idiopathic arthritis
- Ankylosing spondylitis
- Psoriatic arthritis
- Systemic lupus erythematosus
- Antiphospholipid syndrome
- Systemic sclerosis (scleroderma)
- SUMMARY AND RECOMMENDATIONS