Perioperative management of the patient with rheumatoid arthritis

作     者：Megan L Krause Eric L Matteson 

作者机构：Division of RheumatologyDepartment of MedicineMayo ClinicRochesterMN 55905United States 

出 版 物：《World Journal of Orthopedics》 (世界骨科杂志（英文版）)

年 卷 期：2014年第5卷第3期

页      面：283-291页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Rheumatoid arthritis Perioperative management Disease modifying antirheumatic drugs Tumor necrosis factor inhibitors Postsurgical complications 

摘      要：A multidisciplinary approach is required to care for patients with rheumatoid arthritis(RA)in the perioperative *** preparation for surgery,patients must have a cardiovascular risk assessment performed due to the high risk of heart disease in patients with *** of RA is with immunomodulatory medications,which present unique challenges for the perioperative ***,there is no consensus on how to manage disease modifying antirheumatic drug(DMARD)therapy in the perioperative *** of the data to guide therapy is based on retrospective cohort *** regarding DMARDs require an individualized approach with collaboration between surgeons and *** regarding biologic therapy is to hold the therapy in the perioperative period with the length of time dictated by the half-life of the *** attention is required at the time of surgery for potential need for stress dose ***,there must be close communication with anesthesiologists in terms of airway management particularly in light of the risk for cervical spine *** are no consensus guidelines regarding the requirement for cervical spine radiographs prior to ***,history and exam alone cannot be relied upon toidentify cervical spine *** with RA who undergo joint replacement arthroplasty are at higher risk for infection and dislocation compared to patients with osteoarthritis,necessitating particular vigilance in postoperative follow *** review summarizes available evidence regarding perioperative management of patients with RA.