Perioperative use of methotrexate.

Methotrexate (MTX) is the disease modifying antirheumatic 'anchor' drug for the treatment of patients with rheumatoid arthritis (RA). Despite its widespread use and the frequent need of elective orthopaedic and other types of surgical procedures in patients with RA, some confusion exists concerning the use of MTX in the perioperative period. Currently available data do not suggest a need to discontinue MTX because of surgery. There is some evidence that treatment with MTX is safe prior to and after elective surgical procedures. Importantly, disease activity is better controlled when MTX is not interrupted from weekly administration.