URGENT - can I have elective surgery whilst RA is flaring ?

[lindyloo2018]

does anyone know what the recommended practice is regarding an RA flare and elective surgery?

my RA is still flaring and I have yet to start a 3 week prednisolone course.

is it considered safe to have elective surgery to my left wrist when I have active RA in my right elbow?

I know if I take the pred I will have to postpone the op, but if I don't take the pred course, should surgery go ahead ?

I don't know what the recommendations are, my RA cons says ask my hand surgeon and my hand surgeon says ask my RA consultant,

does anyone have any personal experience or similar knowledge gleaned in this area?

please reply asap

many thanks

[Amnesiac3637]

Firstly, how ridiculous that you are being bounced from one consultant to another. Your surgeon is the one who has the ultimate responsibility and would have the final say as to whether he/she is happy to operate so I would contact their secretary and get a definitive answer. This should not be up to you to worry about!

If it helps, I have had lots of operations on various joints over the past 34 years flaring or not and have been on Prednisolone all that time. If you’re on Pred the anaesthetist will often give a depot dose so you’re covered in case of adrenal problems and to allow inflammation to settle. They certainly wouldn’t stop long-term prednisolone for an operation in case of adrenal insufficiency.

If you’re not taking it at the moment you need a consultant to tell you whether to commence a course of it or not -we can’t advise you on that. If you’ve been waiting the required endless years for an operation then have it done flaring or not! Who knows when you might get a better offer………

All the very best and do contact your surgeon!

[lindyloo2018 in reply to Amnesiac3637]

it's a high dose pred course for 3 weeks , 15mg,10mg,5mg, I will have to hold off surgery until steroids wear off. but the RA is still not under control. and will not be until after surgery or does the pred fix it enough for surgery ?

many thanks

..i am in a panic..

[Amnesiac3637 in reply to lindyloo2018]

Do not panic! 🥰 That just makes everything ten times worse. I’m not sure why you’re having a course of prednisolone but it would indicate that your inflammation should be brought under control as that’s what prednisolone does. You really must speak to your consultants or your GP to get this straight in your mind for you and give you relief from anxiety. I really can’t advise you other than that. All best, don’t get in a state, take control!

[Mmrr]

I've had two surgeries and three tooth extractions whilst taking prednisone. Each time I was given a double dose of prednisolone on the day of surgery in case of any adrenal problems. My surgeon and dentist both gave me clear straight forward instructions, my rheumatologist was not involved.

One of the surgeries was elective and all three dental extractions were too.

[bpeal1]

Ultimately it’s the surgeon’s decision. If they said ask your rheumatologist and the rheumatologist said it’s up to the surgeon then I would go back to the surgeon and say that. Ring or email the surgeons secretary tell them what the rheumatologist said and ask them to contact the rheumatologist directly if they need any more clarification.

I think the problem may be that the risks for different types of surgery are different and the surgeon will have greater knowledge of this, whilst different doses of steroids and being in flare will be a different level of risk for different people and the rheumatologist will have better knowledge of this.

[wilbertjellyfish]

Lol. If the delay to your surgery is going to be too long to wait I'd get the surgery and hope you can cope with neither arm being ok. However, I'd imagine it would be better not to have a flare going for surgery. Equally that might be months or years.

[Portinatx17]

Tbh I would seek advice from RA Dr and Orthopaedics. I had a knee replacement in full flare and had to stop meds 2 wks before and after. This was Feb this year, it took until June to get back under control, blood pic was very elevated however.

[Tortoise18]

Hi

I can’t make any comment on the prednisone as I haven’t taken that since I was a child. However, for me it’s a catch 22 with surgery and flares as having to stop my methotrexate and biologic prior to surgery causes me to go into a flare so it’s unlikely I would have surgery without being in a flare if that makes sense. Even worse for me if the op is postponed and even longer off the meds. No one has mentioned to me any issues of flaring during surgery. The only thing they worry about is my haemoglobin levels and that I must stop the immunosuppressants to reduce infection risk of surgery.

I would go back to either your surgeon or rheumatologist and ask for a clear answer about the prednisone.