Gloucestershire Joint Formulary - Shared Care Guidelines

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Perioperative DMARD Guidelines

Patients and clinicians often ask whether specialist medications for arthritic conditions should be stopped in the perioperative period.  The rheumatology department guidelines are as follows, taken from GHNHSFT's intranet site (please note, individual surgeons may have different protocols).

Name of medication

Advice

Hydroxychloroquine safe to continue
Sulphasalazine safe to continue
d-Penicillamine safe continue
Leflunomide omit on the day of surgery
Gold injections omit if medication due the week before surgery
Azathioprine omit one week prior to surgery and restart once the wound is clean and healing
Methotrexate omit one week prior to surgery and restart once the wound is clean and healing
Etanercept / Enbrel stop at least one week prior to surgery and restart once sutures removed and wound is clean and healing
Adalimumab / Humira stop at least one week prior to surgery and restart once sutures removed and wound is clean and healing
Certolizumab / Cimzia stop at least one week prior to surgery and restart once sutures removed and wound is clean and healing
Golimumab / Simponi stop at least one week prior to surgery and restart once sutures removed and wound is clean and healing
Infliximab / Remicade arrange surgery for mid treatment cycle and restart once sutures removed and wound is clean and healing
Rituximab / MabThera arrange surgery for mid treatment cycle and restart once sutures removed and wound is clean and healing
Tocilizumab / RoActemra arrange surgery for mid treatment cycle and restart once sutures removed and wound is clean and healing
Abatacept / Orencia arrange surgery for mid treatment cycle and restart once sutures removed and wound is clean and healing
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