Optimizing Medical Therapy Before & After Surgery for Rheumatic Patients: A Clinician's Guide (2026 CCHM)

Learning Objectives:

• Medication Management Is the Most Modifiable Risk Factor, majoirty of inflammatory arthritis patients are on DMARDs and biologics at time of surgery. Optimizing these agents — especially minimizing glucocorticoids — is the most accessible and impactful preoperative intervention.
• Recognize Diagnosis-Specific Complication Patterns AS: pulmonary compromise from chest wall restriction → highest pneumonia risk. PsA: comorbidities and obesity drive adverse events, not disease activity. RA: infection remains the most concerning adverse event.
• Implement the Guideline Framework with Nuance ACR guideline recommendations are all conditional — no RCT data exist. Confounding by indication and publication bias limit certainty. Individualized, shared decision-making between rheumatologist, surgeon, and patient is paramount.