Planning an operation or a dental procedure raises the same question every time: what do I do about my medicines? The answer differs by drug and by procedure, and getting it wrong in either direction causes problems. Stopping too much risks a flare at exactly the wrong moment; stopping too little can slow wound healing.
Always ask before you stop anything. What follows is the general shape of the advice, not a substitute for a plan made for you.
Dental work
Routine dental treatment — scaling, fillings, a straightforward extraction — does not usually require any medicine to be stopped. That includes methotrexate and, in most cases, biologic treatment.
Tell your dentist what you take. If you are on a steroid or a biologic, that is worth them knowing, particularly for a longer procedure or if an infection is already present. Antibiotic cover is not routinely needed for most people, but is worth asking about if you have a joint replacement or valve disease.
Methotrexate and similar drugs
Methotrexate is generally continued through surgery. The evidence is reasonably clear that continuing it does not increase infection or wound problems, and stopping it commonly triggers a flare in the weeks afterwards, when you can least afford one.
Leflunomide, sulfasalazine and hydroxychloroquine are usually continued as well. Where kidney function is likely to be affected by the operation, methotrexate may be held briefly — that is a decision for the team looking after you.
Biologic and targeted treatments
These are the ones that usually need timing. For major surgery, the general approach is to schedule the operation at the end of a dosing cycle, so the procedure falls at the point when drug levels are lowest, and to restart once the wound has healed and there is no sign of infection — typically around two weeks afterwards.
Because dosing intervals differ so much between drugs — weekly, fortnightly, monthly, eight-weekly — the timing has to be worked out for your specific treatment. Give the clinic as much notice as you can. A week is workable; a day is not.
Steroids: the exception
Steroids are the one thing that must not be stopped. If you take prednisolone regularly, your body's own steroid production is suppressed, and surgery is precisely the situation in which the body needs more, not less.
Make sure the surgical and anaesthetic teams know. Additional steroid cover is often given around the operation. Never omit a dose because you have been told to be nil by mouth without asking how it should be managed.
What to tell the surgical team
- Every rheumatology medicine you take, with doses and how often
- When you last had a biologic dose
- Whether you take a steroid, and for how long you have taken it
- Any joint replacement or implanted device
- Whether your neck is involved by inflammatory arthritis — this matters for positioning during anaesthesia, and is easy to overlook
After the operation
Restart what was held once healing is under way and there is no infection. If a wound is slow to heal or looks infected, biologic treatment stays paused until it has settled.
A flare in the weeks after surgery is common, partly because treatment was interrupted and partly because of the physical stress. It is easier to manage if the clinic knows an operation is coming, so tell us in advance rather than afterwards.
This article is general information and does not replace a consultation.