Perioperative Management in Patients with Rheumatoid Arthritis

he surgical treatment of patients with rheumatoid arthritis requires a great deal of experience. Therefore, the indication for surgery should be based on interdisciplinary collaboration between a surgeon specialised in rheumatic orthopaedic surgery and an internal medicine specialist. When operating on these patients, specific strategies need to be pursued as the disease significantly complicates the perioperative management due to its systemic nature and numerous comorbidities as well as through drug-related complications and simultaneous defect situations in several joints. Consequently, close collaboration between anaesthesiology and surgery is necessary for the surgical procedure to be carried out successfully. Also the postoperative treatment is complicated by existing defect situations in other joints, often with greatly reduced load bearing capacity. Furthermore, the disease itself and its drug treatment may lead to immunodepression with severe complications.