Preoperative evaluation of patients with rheumatoid arthritis

Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxation in rheumatic diseases

The value of lateral view cervical spine radiography in various positions of the neck was assessed in patients with rheumatoid atlantoaxial subluxation (AAS). We wanted to find out how much information is lost if only neutral position radiographs are used. The series consisted of 65 rheumatoid patients with unstable AAS. Lateral view cervical spine radiographs were taken in the neutral position and during flexion and extension. Neutral position radiographs would have failed to confirm the diagnosis of AAS in 31 cases (48%) and would have failed to record its true severity in 43 cases (66%); their diagnostic sensitivity was 52%. The sensitivity of the neutral radiographs in showing the reversibility of AAS was 48%. Routine cervical spine radiography of rheumatoid patients should include lateral view radiographs taken during flexion and extension. The result may be applied to magnetic resonance imaging, which is usually performed in the neutral position.

Perioperative management of the rheumatoid patient

Rheumatoid arthritis is a systemic disease that can affect multiple organ systems of the body. It is a symmetrical polyarthropathy which leads to destruction of cartilage and bone. Before undertaking surgery on the rheumatoid patient, several issues need to be addressed. A thorough evaluation by a multidisciplinary team is essential to decrease any operative risks involved. This is a review of some of the systemic manifestations of rheumatoid arthritis with an emphasis on anesthesiology, and radiological consultation, and perioperative surgical management of rheumatoid drug therapy.

Management of the patient with rheumatic diseases going to surgery

This article reviews the perioperative management of rheumatoid arthritis, gout, systemic lupus erythematosus, scleroderma, and ankylosing spondylitis. It discusses the unique interactions between each rheumatologic disease and a surgical challenge and provides guidelines for the assessment of patients preoperatively. The available literature on surgical risks is analyzed, and approaches are suggested to both reduce postoperative complications and control the rheumatic disease. It is hoped that this will aid the internist in evaluating and treating the rheumatic patient undergoing surgery.

Local infectious complications following large joint replacement in rheumatoid arthritis patients treated with methotrexate versus those not treated with methotrexate

We performed a 10-year retrospective analysis of the frequency of local postoperative infectious complications in methotrexate (MTX)-treated rheumatoid arthritis patients who underwent total joint arthroplasty. Sixty patients, who had a total of 92 joint arthroplasties, were receiving MTX. A comparison group of 61 patients with a combined total of 110 total joint arthroplasties were not receiving MTX. The 2 groups were compared for the occurrence of local postoperative infectious complications and poor wound healing. Eight patients in the MTX group experienced a total of 8 complications (8.7% of procedures). In comparison, 5 patients in the non-MTX group experienced a total of 6 complications (5.5% of procedures), a difference that was not statistically significant (chi 2 = 0.816, P = 0.366). Statistical analysis of many other variables revealed none that could be identified as risk factors for postoperative complications. These results suggest that treatment in the perioperative period with weekly low-dose pulse MTX does not increase the risk of local postoperative infectious complications or poor wound healing in rheumatoid arthritis patients who undergo total joint arthroplasty.

Early morbidity after total hip replacement: rheumatoid arthritis versus osteoarthritis

The authors used the California Health Facilities Discharge data for 1984 and 1985 to compare retrospectively in-hospital morbidity and mortality of all 721 patients with rheumatoid arthritis versus all 8,859 patients with osteoarthritis who underwent a non-emergent, first-time, unilateral total hip arthroplasty. The lengths of hospitalization, in-hospital mortality rates, and incidences of postoperative complications were similar in the two groups except for higher rates of wound infection and wound dehiscence in the patients with rheumatoid arthritis and a higher rate of thromboembolic events in the osteoarthritis group. The short-term outcome of patients with rheumatoid arthritis appears comparable to that of patients with osteoarthritis.