Disease specific precautions should be considered in rheumatic diseases other than RA

What other disease specific precautions should be considered in rheumatic diseases other than RA?

• Sjögren’s syndrome: use lubricating gel and artificial tears during anesthesia to prevent corneal abrasion. Do not give pilocarpine preoperatively to avoid bronchospasm and bradycardia. Minimize the use of anticholinergic drugs during the perioperative period. Dryness may increase the risk of pneumonia.

• Juvenile idiopathic arthritis: micrognathia may make intubation difficult. Cervical spine instability can occur.

• Ankylosing spondylitis: cervical spine immobility may make intubation difficult. Restrictive chest excursion may increase the risk of pneumonia. Heterotopic ossification can complicate THA.

• Psoriatic arthritis: skin disease can flare at the surgical site (Koebner phenomenon).

• Active vasculitis: arterial punctures or devices (e.g., arterial line for blood pressure monitoring) can lead to vasospasm and increased risk for vascular occlusion.

• SLE: treat with IVIG if the patient has severe thrombocytopenia and needs emergency surgery. There is increased CV risk.

• Raynaud’s syndrome: finger sticks for glucose or other monitoring may lead to wounds that are difficult to heal; oxygen saturation monitors may not be accurate in Raynaud’s and therefore, other sites (e.g., forehead, earlobe) for monitoring may be considered.

• Systemic sclerosis: poor venous access at sites of thickened skin; difficult intubation if decreased oral aperture (less than 4 cm incisor to incisor; consider fiberoptic intubation); risk of aspiration increased (esophageal dysmotility); postoperative ileus increased; arterial vasospasm increased in all organs including heart and kidneys; increased risk of scleroderma renal crisis in hypovolemic conditions. Increased risk of adverse outcome in patients with pulmonary hypertension. Increased cardiac arrhythmia risk.

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