This was a question raised by a woman at the bariatric surgery informational seminar I spoke at today. She has had rheumatoid arthritis for several years and is on methotrexate, an immunosuppressant, and treats flare ups with prednisone. All of these medicines suppress inflammatory activity to keep her rheumatoid arthritis under control but for the same reason they will make healing more difficult.
The overall goal is to allow her to heal normally around the time of her operation but to resume her medications as soon as possible after adequate healing is obtained. We therefore want to stop any medicines that will interfere with wound healing at the right time so the negative effect of the medicines are suspended for about three weeks after her operation since about 80% of healing is completed by three weeks after an operation.
For instance: she takes methotrexate once a week. I would suggest that she take her last dose 2 weeks before surgery so it will be out of her system when she has her operation. She could then resume her methotrexate 3 weeks after her operation.
Similarly for her immunosuppressant, she should discontinue this medication so it’s effect is gone when she has surgery and it could be resumed after 3 weeks of healing assuming she has no infections and all is going well.
I would prefer that she reduce her prednisone to 7.5 mg per day or less but we could use higher doses of steroids in she had a flare up while off of her medications.
To control her joint pain while off of her other medicines we will need to use narcotics such as Percocet and/or she may need to be on a Fentanyl patch for a few weeks.
In this way we should be able to reach the goals of appropriate healing and manage her joint pain. This may sound complicated but it is not an uncommon scenario and patients do well with this approach.
No comments:
Post a Comment