Perioperative management of the patient with rheumatoid arthritis

Abstract

A multidisciplinary approach is required to care for pa-

Expectations and experiences of patients with osteoarthritis undergoing total joint arthroplasty: An integrative review

“…Unpublished studies in the form of dissertations and theses were included to reduce publication bias (Trespidi, Barbui, & Cipriani, ). Studies were excluded if they (1) involved patients with trauma or rheumatoid arthritis as the conditions were known to differ in pathogenesis, prognosis, and management from OA (Krause & Matteson, ; Sohail, Anesti, Hanna, Khan, & Malik, ), (2) duplicated publications or publications using replicated patient data, and/or (3) secondary research and/or commentaries, editorials, expert opinions, and books. Uncertain cases were discussed with the second reviewer, A.J.Q.T., to achieve consensus for article inclusion.…”

Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: Prevention and Diagnosis

“…Glucocorticoids are used to manage both disease activity and flares in patients with RA and other inflammatory arthropathies [16••, 56, 57]. Traditionally, supra-physiologic “stress-dose” steroids were given to manage hemodynamic instability and adrenal insufficiency following the cessation of daily corticosteroid usage.…”

“…For bilateral procedures, hydrocortisone 100 mg could be given intraoperatively, followed by additional dosing every 8 h for 24 h, and a taper over the subsequent 24 h until the preoperative dose is met [46]. However, recent literature which reflects advances in anesthesia and surgical technique supports administration of the patient’s daily dose of glucocorticoid instead of giving stress doses due to the higher risk of infection associated with high perioperative stress doses [16••, 46, 56]. Continuing home doses of steroids perioperatively specifically refers to adult patients who are taking less than 16 mg per day with a diagnosis of RA, ankylosing spondylitis, or psoriatic arthritis and not to patients with juvenile idiopathic arthritis [16••].…”

Rheumatoid Arthritis

“…The use of warm hydrotherapy, electrical, and thermal modalities has shown favorable results in the literature (1,54). The physician may also prescribe specific medication such as nonsteroidal anti-inflammatory medication (e.g., ibuprofen) or disease-modifying antirheumatic drugs (Table 2) (33,38). Other medications that may be prescribed include Strength and Conditioning Journal | www.nsca-scj.com corticosteroids, biological agents, and antimalarial medication (18,33).…”