Lupus Clinic, Department of Rheumatology and Medical Sciences, ASST Pini-CTO, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Adv Ther. 2018 Apr;35(4):439-456. doi: 10.1007/s12325-018-0686-0. Epub 2018 Mar 20.
Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process. However, guidelines of different medical societies may vary and are sometimes contradictory. Orthopaedics should collaborate with rheumatologists, anaesthesiologists and, when needed, cardiologists and haematologists with the common aim of minimising perioperative risk in patients with inflammatory rheumatic diseases. The aim of this review is to provide the reader with simple practical recommendations regarding perioperative management of drugs such as disease-modifying anti-rheumatic drugs, corticosteroids, non-steroidal anti-inflammatory drugs and tools for a risk stratification for cardiovascular and thromboembolic risk based on current evidence for patients with inflammatory rheumatic diseases.
患有炎性风湿病的患者常因关节受累而需要骨科手术。全髋关节置换术和全膝关节置换术是这些患者常见的手术。由于炎性风湿病的复杂性，这些患者的围手术期管理必须设想采用多学科方法。在评估患者围手术期风险时，必须考虑到与关节外合并症的频繁关联，并且应该指导临床医生的决策过程。然而，不同医学协会的指南可能有所不同，有时甚至相互矛盾。骨科医生应该与风湿病学家、麻醉师合作，并且在必要时与心脏病专家和血液学家合作，共同努力降低炎性风湿病患者的围手术期风险。本篇综述的目的是为读者提供有关炎性风湿病患者围手术期药物管理的简单实用建议，例如疾病修饰抗风湿药物、皮质类固醇、非甾体抗炎药以及基于当前证据的心血管和血栓栓塞风险分层工具。
