DMARDS and joint replacement

[DrWhoFan]

Is it right that if one is having joint replacement surgery, you have to come off drugs for 1 month before and 2 months after the operation? If so, what happens to your RA? Do you then suffer flares etc? Anne

[cathie]

I'll be interested to hear this as i may need a knee replacement. I know someone who has recently had one (she hasn't got RA) but was given co-codamol + another anti-inflammatory and stuff to cool down her joints. That would help a bit with the RA, but its rather a downer isn't it.

I wonder whether it will depend on the meds and how long it takes for it to lose its efficacy.

[DrWhoFan in reply to cathie]

I have concerns, I must admit. My hip is bad and the surgeon said it does need replacing, but as I am back on steroids he wanted to wait 6 months to see what effect they had. My hip is OA, but my RA causes both my knees to swell up. It would just be my luck , if I did have to stop the leflunomide to replace the hip, that the knees swelled up and stopped my doing the physio!

[hatshepsut]

Hi, I had a knee replacement 3 months ago. I had to stop my biologic 2 full weeks before, and had to wait for the scar to fully heal before re starting it. About a month. I stayed on all other drugs, MTX, ETORICOXIB, hydroxy chloroquine, etc and painkillers. After the op, I had a longlasting morphine pill, daily, plus morphine based pills whenever I needed, plus paractamol, and my own meds, apart from usual pain pills. Plus heparin injections to stop blood clots.

I was back on all my meds, apart from the biologic, on discharge.

I did notice the lack of the biologoc, joints a bit sorer, etc, but honestly the relief of not being in constant excruciating pain from my knee more than compensated for it!

The pain relief is vital, so that you can do the exercises properly.

The reason for coming off the biologic is that there would be a much greater risk of infection after the op.

Hope this has been helpful. M x

[cathie in reply to hatshepsut]

How did you manage coming off pain relief?

[DrWhoFan in reply to hatshepsut]

That is very helpful. When I was on Mtx I was told it would stop your body dealing with infection too. I am surprised you were able to keep on your meds. I have no experience of biologics. Mtx and sulpha both failed with me, I have now been on leflunomide since January together with steroids (again!), which so far seem to be working, but also have sciatica in the same leg. At the moment it's difficult to say where the pain is coming from!

[DrWhoFan in reply to hatshepsut]

Forgot to ask how are you getting on now with new knee.....so rude of me! X Anne

[lilianisaac]

I had neck surgery and came off my biologics two weeks before but was able to resume them about two weeks after surgery. I also take Leflunomide 20mg and celebrex (NSAID) and I did not have to stop taking them at all. Hope this helps. Pat

[DrWhoFan]

Hi Pat, thanks, that does help. Anne x

[Hidden]

I have been off biologics for a while as blood tests were iffy with Rituximab. However, on hearing that I needed a hip replacement and me saying how good it was I was not on any heavy duty stuff, my rheumatologist laughed and said he would have had no problem if I had been and wouldn't see any reason to stop it even for major surgery but it's the surgeons who are not necessarily au fait with all the rheumatology drugs and so won't take any chances. I see the point - rather safe than sorry but wouldn't it be good if they all liaised properly with each other's specialism?!

[DrWhoFan in reply to Hidden]

I totally agree with you. How were you before you had your hip done? Mine is 'moderate to severe wear, with pits on the ball joint, and places with no gap'. I saw a surgeon in March, who wanted to wait till September. Some days I am in extreme pain others no so bad. It's very confusing. Anne

[Hidden in reply to DrWhoFan]

I was awful before I had my hip done two weeks and three days ago and now I'm fine and pain free! Hooray! I had the same as you and because I have RA it affected my hip with inflammation as well as the osteoarthritis in the joint. The surgeon said he could inject under ultrasound and then said he was just delaying the inevitable hip replacement so I had it done within 10 weeks of seeing him. Been fabulous. Tired and slow but pain free and very relieved I no longer have the grinding pain on walking, sitting, lying....Get yours done asap and you won't regret it. Good luck to you.

[DrWhoFan in reply to Hidden]

Thanks so much for your reply. To be honest I have been quite frightened about having it done, but you have given me courage! Please keep in touch if you can, so I can see how you are progressing! Anne

[Hidden in reply to DrWhoFan]

With pleasure. There's also loads of my posts on the Patient.co.uk website under hip replacement. Lots of us old and new hippies discuss every aspect of the surgery, there's heaps of tips and advice (some good, some well worth not reading as now and then there's scary stories) and really good support. As I said, I've had a really good experience and if you've got a good hospital and surgeon and a positive attitude it's the best present you can give yourself.

[hatshepsut]

I'm doing well thanks. I had no problems with pain relief, my usual dihydrocodeine was replaced post op with morphine, and resumed on discharge. In fact pain relief was superb! Necessary of course, as the physio is quite demanding! For me, the care was excellent.

If you have any other questions, I'm happy to try to answer them! M x

[DrWhoFan]

Thanks x