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Life sciences · Journal article
Journal of the American Academy of Orthopaedic Surgeons · August 7, 2026
A consensus or society position rather than new primary data.
This is a narrative review addressing perioperative management of antirheumatic medications in orthopaedic surgery, synthesizing evidence to guide clinical decisions on medication timing and monitoring. The review acknowledges substantial knowledge gaps, particularly for newer biological therapies and procedures beyond joint arthroplasty, and calls for multidisciplinary approaches to optimize outcomes.
Journal article. Orthopaedic surgery patients on antirheumatic medications for rheumatoid arthritis, psoriatic arthritis, lupus, and other inflammatory conditions..
Antirheumatic medications disrupt wound healing at multiple stages, affecting early inflammatory responses and collagen remodeling. Current evidence is largely limited to joint arthroplasty in rheumatoid arthritis patients, with notable gaps for other procedures and newer medications. Management decisions are complicated by inconsistent guidelines and limited data on newer biological therapies.
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Surgeons should recognize the trade-off between medication continuation (infection and wound healing risk) and discontinuation (disease flare risk), and should use multidisciplinary approaches to optimize perioperative management. The review underscores uncertainty in current practice and the need for individualized decision-making pending further evidence.
A narrative review synthesizing evidence on perioperative antirheumatic medication management to inform clinical decision-making, without new primary data or a systematic appraisal of existing literature.
Surgeons should recognize the trade-off between medication continuation (infection and wound healing risk) and discontinuation (disease flare risk), and should use multidisciplinary approaches to optimize perioperative management. The review underscores uncertainty in current practice and the need for individualized decision-making pending further evidence.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
Orthopaedic surgeons frequently treat patients on antirheumatic medications for rheumatoid arthritis, psoriatic arthritis, lupus, and other inflammatory conditions. When these patients require surgery, surgeons face competing therapeutic priorities: continuing medications risks impaired wound healing and infection, whereas discontinuing them may trigger disease flares and functional decline. Management decisions are further complicated by inconsistent guidelines and limited data on newer biological therapies. Antirheumatic medications disrupt wound healing at multiple stages,some affect early inflammatory responses, whereas others interfere with collagen remodeling. These wound healing disruptions are especially concerning in high-risk patients, such as those with cancer, where complications can derail overall treatment plans. Current knowledge is largely limited to joint arthroplasty in rheumatoid arthritis patients, leaving notable gaps for other procedures and newer medications. This review addresses these gaps by providing evidence-based guidance for medication timing, dosing adjustments, and monitoring strategies, emphasizing multidisciplinary approaches to optimize surgical outcomes.
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