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Abstract
As elderly population is growing rapidly, the number of patients with arthritis is also increasing. Because of the prolonged lifetime, arthritic patients become to have more chances to undergo surgical procedures. Many of these patients chronically receive medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid, and various disease-modifying anti-rheumatic disease (DMARDs) including biologic agents. Decisions regarding withholding or modifying the regimens of these medications may be critical in the perioperative period to optimize surgical outcome. Consultation with a rheumatologist is recommended, but the surgeon also should be aware of these medications. This review article suggests a balanced perioperative medication management to minimize potential surgical complications and maintain disease control in arthritic patients.
References
1. 통계청. 고령자통계. 통계청자료. 2003. 10.
2. 국민건강ㆍ영양조사. 노인건강실태, 보건복지부. 1999. 12.
3). 3). 국민건강ㆍ영양조사. 총괄보고서, 보건복지부. 1999. 12.
4. Abramson S, Weissmann G. The mechanisms of action of nonsteroidal antiinflammatory drugs. Clin Exp Rheumtol. 1989; 7(Suppl 3):163–70S.
5. Brooks PM, Day RO. Nonsteroidal antiinflammatory drugs-differences and similarities. N Engl J Med. 1991; 324:1716–25.
6. Vane JR, Bakhle YS, Botting RM. Cyclooxygenase 1 and 2. Annu Rev Pharmacol Toxicol. 1998; 38:97–120.
7. Schafer AI. Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis. J Clin Pharmacol. 1995; 35:209–19.
8. Kantor TG. NSAIDs, salicylates, and coagulation. In: Famaey JP, Paulus HE, eds. Therapeutic applications of NSAIDs. p.265–78. New York, Marcel Dekker, Inc.,. 1992.
9. Connelly CS, Panush RS. Should nonsteroidal antiinflammatory drugs be stopped before elective surgery? Arch Int Med. 1991; 151:1963–6.
10. Robinson CM, Christie J, Malcolm Smith N. Nonsteroidal antiinflammatory drugs, perioperative blood loss, and transfusion requirements in elective hip arthroplasty. J Arthropalsty. 1993; 8:607–10.
11. Amadio P Jr, Cummings D, Amadio P. Nonsteroidal antiinflammatory drugs. Tailoring therapy to achieve results and avoid toxicity. Postgrad Med. 1993; 93:73–97.
12. Rosandich PA, Kelley JT 3rd, Conn DL. Perioperative management of patients with rheumatoid arthritis in the era of biologic response modifiers. Curr Opin Rheumatol. 2004; 16:192–8.
13. Patrono C. Aspirin as an antiplatelet dug. N Eng J Med. 1994; 330:1287–94.
14. Finckh A, Aronson MD. Cardiovascular risks of cyclooxygenase-2 inhibitors: where we stand now. Ann Intern Med. 2005; 142:212–4.
15. Olekers W. Adrenal insufficiency. N Engl J Med. 1996; 335:1206–12.
16. Lamberts SW, Bruining HA, deJong FH. Corticosteroid therapy in severe illness. N Engl J Med. 1997; 337:1285–92.
17. Salem M, Tainsh RE Jr, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage. A reassessment 42 years after the emergence of a problem. Ann Surg. 1994; 219:416–25.
18. LaRochelle GE Jr, LaRochelle AG, Ratner RE, Borenstein DG. Recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients with rheumatic diseases receiving low-dose prednisone. Am J Med. 1993; 95:258–64.
19. Schlaghecke R, Kornely E, Santen RT, Ridderskamp P. The effect of longterm glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N Engl J Med. 1992; 326:226–30.
20. Livanou T, Ferriman D, James VH. Recovery of hypothalamo-pituitary-adrenal function after corticosteroid therapy. Lancet. 1967; 2:856–9.
21. Graber AL, Ney RL, Nicholson WE, Island DP, Liddle GW. Natural history of pituitary-adrenal recovery following longterm suppression with corticosteroids. J Clin Endocrinol Metab. 1965; 25:11–6.
22. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison's principles of internal medicine. 16th ed. p.2133–4. Seoul, McGraw-Hill,. 2004.
23. Bromberg JS, Alfrey EJ, Barker CF, Chavin KD, Dafoe DC, Holland T, et al. Adrenal suppression and steroid supplementation in renal transplant recipients. Transplantation. 1991; 51:385–90.
24. Glowniak JV, Loriaux DL. A double-blind study of perioperative steroid requirements in secondary adrenal insufficiency. Surgery. 1997; 121:123–9.
25. Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC, et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Eng J Med. 2000; 343:1586–93.
26. Kremer JM, Rynes RI, Bartholomew LE. Severe flare of rheumatoid arthritis after discontinuation of longterm methotrexate therapy. Double-blind study. Am J Med. 1987; 82:781–6.
27. Bridges SL Jr, López-Méndez A, Han KH, Tracy IC, Alarcón GS. Should methotrexate be discontinued before elective orthopedic surgery in patients with rheumatoid arthritis? J Rheumatol. 1991; 18:984–8.
28. Carpenter MT, West SG, Vogelgesang SA, Casey Jones DE. Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy. Orthopedics. 1996; 19:207–10.
29. Grennan DM, Gray J, Loudon J, Fear S. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis. 2001; 60:214–7.
30. Jain A, Witbreuk M, Ball C, Nanchahal J. Influence of steroids and methotrexate on wound complications after elective rheumatoid hand and wrist surgery. J Hand Surg [Am]. 2002; 27:449–55.
31. Kasdan ML, June L. Postoperative results of rheumatoid arthritis patients on methotrexate at the time of reconstructive surgery of the hand. Orthopedics. 1993; 16:1233–5.
32. MacKenzie CR, Sharrock NE. Perioperative medical considerations in patients with rheumatoid arthritis. Rheum Dis Clin North Am. 1998; 24:1–17.
33. Christopher R. Perioperative medication management for the patient with rheumatoid arthritis. J Am Acad Orthop Surg. 2006; 14:544–51.
34. Bibbo C, Goldberg JW. Infection and healing complications after elective orthopedic foot and ankle surgery during tumor necorosis factor-alpha inhibition therapy. Foot Ankle Int. 2004; 25:331–5.
35. Giles JT, Bartlett SJ, Gelber AC, Nanda S, Fontaine K, Ruffing V, et al. Tumor necrosis factor inhibitor therapy and risk of serious postoperative orthopedic infection in rheumatoid arthritis. Arthritis Rheum. 2006; 55:333–7.
36. Schanbacher CF, Bennett RG. Postoperative stroke after stopping warfarin for cutaneous surgery. Dermatol Surg. 2000; 26:785–9.
37. Genewein U, Haeberli A, Straub PW, Beer JH. Rebound after cessation of oral anticoagulant therapy: the biochemical evidence. Br J Haematol. 1996; 92:479–85.
38. Dunn AS, Turpie AG. Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med. 2003; 163:901–8.
39. Wahl MJ. Dental surgery in anticoagulated patients. Arch Intern Med. 1998; 158:1610–6.
40. Alcalay J. Cutaneous surgery in patients receiving warfarin therapy. Dermatol Surg. 2001; 27:756–8.
41. White RH, McKittrick T, Hutchinson R, Twitchell J. Temporary discontinuation of warfarin therapy: changes in the international normalized ratio. Ann Intern Med. 1995; 122:40–2.
42. Spyropoulos AC, Frost FJ, Hurley JS, Roberts M. Costs and clinical outcomes associated with low-molecular-weight heparin vs unfractionated heparin for perioperative bridging in patients receiving long-term oral anticoagulant therapy. Chest. 2004; 125:1642–50.
43. O'Donnell MJ, Kearon C, Johnson J, Robinson M, Zondag M, Turpie I, et al. Brief commuinication: Preoperative anticoagulant activity after bridging low-molecular-weight heparin for temporary interruption of warfarin. Ann Intern Med. 2007; 146:184–7.
Table 1.
Half-life of commonly used non-steroidal antiinflammatory drugs (NSAIDs)
Table 2.
Normal response of rapid ACTH stimulation test
| Serum cortisol 30 min or 60 min after ACTH injection | |
|---|---|
| Stimulated cortisol level | ＞18μg/dL (＞500 nmol/L) |
| Minimal increment of cortisol | ＞7μg/dL (＞200 nmol/L) above baseline |
Table 3.
Recommended supplemental corticosteroid according to the stress levels
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