Perioperative use of immunomodulatory drugs

Ding, 2010Fuerst, 2006Grennan, 2001Heldmann, 2010Pieringer, 2008

When deciding whether to continue immunomodulatory therapy perioperatively, the potential consequences of postoperative infection should be weighed against the potential consequences of a perioperative flare in disease activity—seek specialist advice.

Note: Seek specialist advice about immunomodulatory drug use during the perioperative period.

Systemic corticosteroids must be continued perioperatively. Consider the need for higher doses if there is a risk of adrenocortical suppression—see Glucocorticoid replacement during intercurrent illness and surgery.

There is insufficient evidence to suggest that stopping disease modifying antirheumatic drugs (DMARDs) for surgery reduces the risk of postoperative infectionAustralia & New Zealand Musculoskeletal Clinical Trials Network (ANZMUSC), 2022. The risk of postoperative infection varies between surgical sites (eg colonic resection has a high risk of postoperative infection). The risk of infection needs to be weighed against the risk of a disease flare and any additional therapy required to regain disease control. A discussion between the patient and their surgeon and specialist may be required.