Perioperative Management of Patients with Rheumatic Diseases

Lina Bissar* , 1, Hani Almoallim1, 2, 3, Khaled Albazli2, Manal Alotaibi2, Samar Alwafi2
1 Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
2 Department of Medicine, Medical College, Umm Alqura University, Makkah, Saudi Arabia
3 Alzaidi Chair of Research in Rheumatic Diseases, Medical College, Umm Alqura University, Makkah, Saudi Arabia

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© Bissar et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia; Tel: 966-2-667-7777, Ext. 65045; Fax: 65816; E-mail:


This paper aims to explore the assessment of patients with rheumatologic diseases, especially rheumatoid arthritis (RA), before undergoing orthopedic surgery. Perioperative assessment ensures an early diagnosis of the patient's medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. Perioperative assessment allows for proper postoperative management of complications and of the management of drugs such as disease-modifying anti-rheumatic drugs (DMARD) and anti-platelets, and corticosteroids. The assessment also supports follow up plans, and patient education.

Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making about the assessment and treatment of patients with rheumatologic diseases. It also enables the discussion of both condition and procedure with the patient to ensure a good postoperative care.

The article identifies the components of perioperative medical evaluation, discusses perioperative management of co-morbidities and the management of specific clinical problems related to RA, systemic lupus erythematosus, the management of DMARDs, like methotrexate (MTX) and biologic therapies, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation

Keywords: Perioperative management, rheumatologic disease, perioperative risk assessment, perioperative drug management..