Title

Rheumatoid arthritis: Current pharmacologic treatment and anesthetic considerations

ORCiD

Adam M. Kaye: 0000-0002-7224-3322

Document Type

Article

Publication Title

Praticien en Anesthesie Reanimation

ISSN

1279-7960

Volume

12

Issue

6

DOI

10.1016/j.pratan.2008.10.003

First Page

398

Last Page

407

Publication Date

1-1-2008

Abstract

A diagnosis of rheumatoid arthritis carries with it a lifelong progressive disease; however, some patients enjoy periods of partial to total remission. The disease frequently plagues to small joints; extension to the cervical spine is especially a concern for anesthetists due to the risk of difficult intubation and neurological lesion related to C1-C2 subluxation. Treatments such as NSAID's and steroids convey a risk of complications such as infection but need to be continued or substituted. Methotrexate is also a risk factor of septical complication due to its immunosuppressive effect. Preoperative evaluation has to consider systemic complication that may interfere with anesthetic management such as pericarditis or interstitial pneumonia. Regional anesthetic techniques must be favored in as much as possible while a special attention must be paid to patient positioning during surgery to avoid painful discomfort. Postoperatively, it is critical to ensure adequate pain control and to maintain preoperative treatments. © 2008 Elsevier Masson SAS.

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