Bissar Lina, Almoallim Hani, Albazli Khaled, Alotaibi Manal, Alwafi Samar
Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
Open Rheumatol J. 2013 Aug 19;7:42-50. doi: 10.2174/1874312901307010042. eCollection 2013.
This paper aims to explore the assessment of patients with rheumatologic diseases, especially rheumatoid arthritis (RA), before undergoing orthopedic surgery. Perioperative assessment ensures an early diagnosis of the patient's medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. Perioperative assessment allows for proper postoperative management of complications and of the management of drugs such as disease-modifying anti-rheumatic drugs (DMARD) and anti-platelets, and corticosteroids. The assessment also supports follow up plans, and patient education. Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making about the assessment and treatment of patients with rheumatologic diseases. It also enables the discussion of both condition and procedure with the patient to ensure a good postoperative care. The article identifies the components of perioperative medical evaluation, discusses perioperative management of co-morbidities and the management of specific clinical problems related to RA, systemic lupus erythematosus, the management of DMARDs, like methotrexate (MTX) and biologic therapies, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation.
本文旨在探讨风湿性疾病患者，尤其是类风湿关节炎（RA）患者在接受骨科手术前的评估。围手术期评估可确保早期诊断患者的病情、整体健康状况、合并症，并评估与拟行手术相关的风险因素。围手术期评估有助于对并发症进行适当的术后管理，以及对改善病情抗风湿药（DMARD）、抗血小板药物和皮质类固醇等药物进行管理。该评估还支持后续计划和患者教育。围手术期评估能够让参与的不同专科医生就每个病例中拟行的治疗方案及其相关因素进行讨论，以便对风湿性疾病患者的评估和治疗做出适当的早期决策。它还能让医生与患者讨论病情和手术，以确保良好的术后护理。本文确定了围手术期医学评估的组成部分，讨论了合并症的围手术期管理以及与RA、系统性红斑狼疮相关的特定临床问题的管理、DMARD（如甲氨蝶呤（MTX））和生物疗法的管理、预防性抗生素以及术后随访，包括患者教育和康复。
