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‘Should we stop or continue conventional synthetic (including glucocorticoids) and targeted DMARDs before surgery in patients with inflammatory rheumatic diseases?’
  1. Susan M Goodman MD1 and
  2. Michael D George MD MSCE2
  1. 1Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
  2. 2Department of Biostatistics, Epidemiology and Informatics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Susan M Goodman, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medicine, New York 10021, USA; Goodmans{at}


Total hip and total knee arthroplasty) remain important interventions to treat symptomatic knee and hip damage in patients with rheumatoid arthritis, with little change in utilisation rates despite the increasingly widespread use of potent conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and targeted DMARDs including Janus kinase inhibitors and biologics. The majority of patients are receiving these immunosuppressing medications and glucocorticoids at the time they present for arthroplasty. There is minimal randomised controlled trial data addressing the use of DMARDs in the perioperative period, yet patients and their physicians face these decisions daily. This paper reviews what is known regarding perioperative management of targeted and csDMARDs and glucocorticoids.

  • Corticosteroids
  • Methotrexate
  • Orthopedic Surgery

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  • Funding The authors report grants from Bristol-Myers Squibb, personal fees from AbbVie, Expert witness testimony, grants and personal fees from Novartis, and personal fees from American College of Rheumatology, outside the submitted work.

  • Competing interests SMG has consulted for Novartis and UCB, and has research funding from Novartis, Pfizer and Horizon Pharma. MDG has consulted for AbbVie and has research funds from Bristol Meyers Squibb.

  • Patient consent for publication Not required.

  • Disclaimer The views expressed in the submitted article are of the authors’ own and are not an official position of the institution.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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