American College of Rheumatology releases newer guidelines for the perioperative management of RA patients undergoing total knee arthroplasty

American College of Rheumatology/American Association of Hip and Knee Surgeons release newer guidelines for the perioperative management of antirheumatic drugs in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty.


The panel comprising of orthopedic surgeons, rheumatologists, and infectious disease specialists has updated the previous 2017 recommendations by including currently available medications, interventions, comparator, and outcomes. The update recommendations suggest withholding JAK inhibitors for 3 days before surgery, including tofacitinib, upadicitinib, and baricitinib. These recommendations are intended for the management of adults with rheumatic diseases, particularly those with inflammatory arthritis and systemic lupus erythematosus undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).


According to the guidelines, the DMARDS namely methotrexate, sulfasalazine and hydroxychloroquine can be continued during surgery. Whereas, infliximab, adalimumab, abatacept etc. need to be discontinued during surgery. The guidelines have also recommended the timing of surgery since  last medication dose. The key objective of these guidelines is to balance the risk of perioperative infection and disease flares, considering the significant impact of these flares on the quality of life and risk for organ damage.


References: [cited 2016 Oct 7]. Available from: