Medical considerations and perioperative care for rheumatoid surgery

Surgery on patients with RA should be undertaken after careful consideration of a number of issues. These include an overall assessment of the status of the patient's arthritis, general health and preparedness for the procedure and the rehabilitation which follows. Special attention must be given to organs that may be affected by the systemic involvement which occurs with rheumatoid disease. Sites requiring specific review include the cervical spine, lungs, airway, bone, and bone marrow. Intraoperatively and postoperatively rheumatoid patients may require supplementary corticosteroids and an adjustment of the dose of their antirheumatic medications. Various systemic rheumatic diseases can have predominantly hand signs and symptoms at their onset. It is valuable to be familiar with the clinical features of gout with tophaceous inflammation, psoriatic arthritis, Raynaud's disease, and amyloidosis.