The Management of Perioperative Immunosuppressant Medications for Rheumatoid Arthritis During Elective Hand Surgery

Purpose: Rheumatoid arthritis (RA) is a destructive inflammatory disease that commonly involves joints of the hand and wrist. Different recommendations exist for continuing or discontinuing immunosuppressant medications during the perioperative time period. The purpose of our study was to determine if continuing steroids, non-biologic DMARDs, and/or biologic DMARDs were associated with an increased risk of postoperative complications. Methods: We performed a single-centered, retrospective review of a consecutive cohort of RA patients who had elective hand surgery by a single surgeon. Patients were included if they had a documented diagnosis of seropositive RA by a rheumatologist, and had elective hand surgery and/or disease-related surgical procedure involving the upper extremity from January 2008 to August 2018. We stratified patients into different groups for comparison by classes of immunosuppressant medications for managing RA. These classes included corticosteroids, non-biological DMARDs, biologic DMARDs, and/or no medications. Groups were then compared for the incidence of postoperative complications. Results: Eighty-eight consecutive patients had elective hand and/or upper extremity surgeries for RA. Mean patient age at the time of surgery (±SD) was 55±13 years (range: 24 to 74 years). Of these 88 patients, eight (9%) overall complications occurred. Complications were wound healing failures, (n=5, 6%), tendon rupture, (n=1, 1%), hematoma, (n=1, 1%), and surgical site infection, (n=1, 1%). Perioperative medications included steroids (n=31), non-biologic DMARDs (n=68), and biologic DMARDs (n=5). There were no significant findings between patients on perioperative corticosteroids, non-biologic DMARDs, and/or biologic DMARDs and the incidence of complications. Mean follow-up was 69±65 weeks (range: 8 to 296 weeks). Conclusions: Patients with RA who continued corticosteroids, non-biologic DMARDs, and/or biologic DMARDS within one dosing interval of their usual dose were not associated with a higher risk for postoperative complications compared to patients discontinuing these medications perioperatively, following elective hand surgery

Compression Neuropathy of the Radial Nerve Due to Ganglion Cysts

Ganglions of the upper extremity are common. Radial nerve dysfunction, particularly radial sensory dysfunction, is a rare finding in association with a ganglion. We present our experience with two such ganglia and a review of the literature