Perioperative Management in Rheumatology: What Patients Need to Know

Perioperative Management in Rheumatology: What Patients Need to Know

Undergoing surgery can be daunting, especially for patients with rheumatic diseases. Conditions like rheumatoid arthritis (RA), lupus, and other autoimmune disorders often require continuous management, which includes specific medications that can affect how the body responds to surgery. This guide will help you understand how rheumatic diseases impact the perioperative period (the time around surgery) and what steps you can take with your healthcare team to ensure a smooth process.

Why Perioperative Management is Important for Rheumatic Disease Patients

Patients with rheumatic diseases are at higher risk for certain complications during and after surgery. These risks can include:

• Increased susceptibility to infections due to immunosuppressive medications or the disease itself.
• Higher rates of delayed wound healing due to both the disease and medications like corticosteroids.
• Risks of disease flare-ups due to stress on the body, medication adjustments, and changes in the immune response.

Proper perioperative management helps minimize these risks and ensures a safer surgical experience.

Key Considerations in Perioperative Management

1. Medication Adjustments

   • Immunosuppressive Drugs: Medications like methotrexate, biologics, or corticosteroids may weaken the immune system, increasing infection risk. In some cases, your rheumatologist and surgeon may advise stopping certain medications temporarily around the time of surgery. For example:
     • Biologics (e.g., TNF inhibitors) are often stopped one to two weeks before surgery and resumed after the wound is healing well, typically about two weeks post-op, depending on the procedure.
     • Methotrexate might be continued in some cases, as stopping it can lead to flare-ups. Studies suggest that, under certain conditions, continuing methotrexate may not increase infection risk.
     • Corticosteroids: If you’re on corticosteroids, adjustments may be necessary to help with wound healing and stress response. Your doctor may increase your dose briefly around the surgery due to the stress response required by the body.

2. Risk of Flare-Ups

   • Surgery is a form of physical stress that can sometimes lead to a flare of your rheumatic disease. Work with your rheumatologist to create a plan for controlling disease activity before, during, and after surgery.

3. Infection Prevention

   • Rheumatic disease patients, especially those on immunosuppressants, have a higher risk of infections. Your healthcare team may recommend:
     • Antibiotic prophylaxis: Antibiotics before surgery can help reduce infection risk.
     • Preoperative screening: Ensuring you are free from any active infections (like a urinary or respiratory infection) before surgery is crucial.
     • Vaccinations: Your rheumatologist may suggest vaccinations (e.g., flu or pneumonia vaccines) several weeks before surgery to further reduce infection risks.

4. Blood Clot Prevention

   • Autoimmune diseases like lupus and certain medications can increase the risk of blood clots. To minimize this, you may need blood-thinning medications or special leg exercises to improve circulation during and after surgery.

5. Wound Healing and Scar Management

   • Delayed wound healing is common for people with autoimmune disorders, particularly if they are taking steroids. Your surgeon will monitor your wound closely, and you may be asked to follow specific wound-care instructions to promote healing.

6. Pre-Surgical Optimizations

   • Controlling your disease activity before surgery is essential. This might involve tweaking medications or lifestyle changes like stopping smoking, eating a balanced diet, and maintaining healthy hydration levels to boost your immune response.

The Role of Your Healthcare Team

Open communication between your rheumatologist, surgeon, and primary care physician is vital for perioperative care. Here’s what each of them may focus on:

• Rheumatologist: Your rheumatologist can help with medication adjustments, flare prevention, and managing disease activity before and after surgery.
• Surgeon: Your surgeon will focus on the technical aspects of your surgery and guide you in pre- and post-operative instructions, including infection prevention and wound care.
• Primary Care Physician: If you have other health concerns like diabetes, high blood pressure, or heart disease, your primary care doctor will ensure these are controlled for safer surgery.

Tips for a Successful Perioperative Experience

• Plan ahead: Meet with your healthcare team well in advance of surgery to coordinate medications and create a comprehensive plan.
• Know your medication instructions: It’s essential to follow specific guidance on when to stop or continue your medications.
• Monitor for symptoms of infection or flare-ups: If you notice signs of infection, like fever, redness, or swelling, contact your doctor immediately.
• Take it easy after surgery: Rest and recovery are crucial. Follow your surgeon’s advice on movement and any physical therapy required.

Final Thoughts

Managing rheumatic disease during the perioperative period requires teamwork and careful planning. By working closely with your rheumatologist, surgeon, and primary care physician, you can optimize your health, minimize risks, and improve recovery outcomes. Remember, every patient’s case is unique, so communicate openly with your healthcare team and follow their individualized advice for a successful surgery and recovery.