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[Continue or interrupt? Antirheumatic treatment in elective surgery].

Katinka Albrecht1, Jan Leipe2

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Summary
This summary is machine-generated.

For patients with rheumatic diseases undergoing surgery, updated German Society for Rheumatology (DGRh) guidelines recommend continuing most disease-modifying antirheumatic drugs (DMARDs) while adjusting glucocorticoid doses. Janus kinase (JAK) inhibitors require a brief interruption before major procedures.

Keywords:
BiologicsDisease-modifying antirheumatic drugsGlucocorticoidsInfectionsWound healing

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Area of Science:

  • Rheumatology
  • Surgical Management
  • Pharmacology

Background:

  • Managing patients with inflammatory rheumatic diseases requires careful consideration of medication during elective surgery.
  • Decisions involve continuing, adjusting, or interrupting treatments like disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids.
  • Updated recommendations are crucial for optimizing patient care and surgical outcomes.

Purpose of the Study:

  • To present updated recommendations from the German Society for Rheumatology (DGRh) for managing antirheumatic medications around elective surgery.
  • To provide guidance on disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids for surgical patients.
  • To facilitate informed decision-making for interdisciplinary teams and patients.

Main Methods:

  • Development of updated clinical practice guidelines by the German Society for Rheumatology (DGRh).
  • Review and synthesis of evidence regarding the perioperative management of various DMARD classes, including conventional synthetic (cs)DMARDs, biologic (b)DMARDs, and Janus kinase (JAK) inhibitors.
  • Consideration of glucocorticoid dosing and infection risk in the preoperative period.

Main Results:

  • Most conventional synthetic (cs)DMARDs can be continued perioperatively.
  • Biologic (b)DMARDs treatment allows surgery scheduling at the end of treatment intervals.
  • Glucocorticoids should be minimized preoperatively due to infection risk; Janus kinase (JAK) inhibitors require a 3-4 day interruption before major surgery.

Conclusions:

  • The DGRh recommendations offer a framework for managing rheumatic medications during surgery, adaptable to individual patient needs.
  • Early postoperative resumption of treatment is advised, contingent on wound healing.
  • These guidelines support safe surgical planning for patients with inflammatory rheumatic diseases on various therapeutic agents.