JAAOS - 2026-08-07 - Journal Article
Perioperative Management of Antirheumatic Medications and Their Effects on Wound Healing in Orthopaedic Surgery.
Ubong SE, Lozano-Calderón SA
Topics
Key Takeaway
Antirheumatic medications disrupt wound healing at multiple stages, but evidence guiding perioperative management is largely limited to joint arthroplasty in RA patients, leaving significant gaps for newer biologics and non-arthroplasty procedures.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This narrative review addresses perioperative management of antirheumatic medications (DMARDs, biologics, targeted synthetic agents) in orthopaedic surgery patients with RA, PsA, lupus, and other inflammatory conditions. The authors synthesize evidence on medication timing, dosing adjustments, and wound healing disruption across drug classes. Existing data are concentrated in TJA for RA; guidance for newer biologics and non-arthroplasty procedures is extrapolated or expert-based.
Key Limitation
The evidence base is almost entirely derived from TJA in RA cohorts, making all recommendations for other procedures and newer biologic classes expert opinion or extrapolation rather than direct evidence.
Original Abstract
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.