is elective surgery safe to have when you are having an Ra flare ?

[lindyloo2018]

hello

I am due to have surgery soon, my flare is still ongoing, waiting for new drugs to work, added hydroxy 200mg daily to my ongoing mtx 15mg weekly because stopping the hydroxy caused the flare.

been 7 weeks since restarting hydroxy and no sign of hydroxy working yet.

my elective surgery is due, asap. does anyone know or have experience of the risks attached to elective surgery during an RA flare (is it bad for RA and/or bad for surgery) and what could be done medically to mitigate surgery risks?

please reply asap tonight if poss. I have appt tomorrow at the hospital and I am running out of time

many thanks

[Madmusiclover]

I’ve had an op with out of control RA yes. Not ideal but needs must. Just had to roll with it. You need to make surgical team aware of any limitations RA may be causing you movement wise. Depends on op I suppose. Mine was recent knee surgery. Had usual gutter crutches afterwards; and told them not to expect me to lift myself up in bed etc.

[lindyloo2018 in reply to Madmusiclover]

so out of control RA, still surgery and stopping and starting RA meds would not have been good for the RA.. what happened to your RA after surgery ? many thanks

[Madmusiclover in reply to lindyloo2018]

Still same/getting worse. But been waiting in new drugs since summer. So not getting worse because of op.

[lindyloo2018 in reply to Madmusiclover]

still getting worse and still waiting for new RA drugs.. does not sound good,did your RA consult or knee surgeon have any advice re the surgery with a flare? low dose prednisolone or something to keep a lid on the RA?

[Madmusiclover in reply to lindyloo2018]

Hi. I can’t take oral steroids.

[KittyJ]

You need to ask this at your appointment tomorrow, if they don’t know the answer they can contact rheumatology. Hydroxy can take a few months to work so you still have a bit longer to go for it to work 🤞🏻

[AgedCrone]

You should contact the surgeon doing the elective surgery….it will depend on how serious that surgery is …& how being in a flair would affect it.

If it,s something that would need exercise soon after when you would need rest ….then it may not be a good idea….but only your medical team can advise you.It’s a shame you didn,t check sooner.

[lindyloo2018 in reply to AgedCrone]

many thanks - yes I asked both consultants last year, RA consultant said did he did not know and to ask the surgeon, I then asked the surgeon and he said don't know ask the RA consultant - a no win situation. 3 months extensive physio is required on the operated part straight after stitches out. my RA is still not quite 'back to normal' in that it is still not under control, or at least not as under control as it was before I had the RA meds hiccup. I am crossing my fingers that hydroxy will kick back in over the next few months.

[welsh12 in reply to lindyloo2018]

Hi are you not on the max dose of hydroxychloroquine 400mg? Also you normally have a pre op assessment where you share any issues which is done quite close to any op to ensure there are no current issues. I only had wisdom teeth out but they were very through if I had a sore throat they wouldn't have done it.

[welsh12 in reply to lindyloo2018]

Just read your bio don't know if you have tried other meds as they don't seem to be working from what you say.

[lindyloo2018 in reply to welsh12]

no we have just increased mtx and restarted hydroxy for now to see if that works.

was suggested to max out hydroxy in the short term but it's weight dependant and I do not want to OD on hydroxy. think hydroxy may need another month before changing something else meds wise..

[welsh12 in reply to lindyloo2018]

Best of luck with it

[RainbowLeopard]

I had minor surgery last week and a flare over Christmas hasn't properly settled yet. It's been fine, though the swelling in my wrists gave the nurse a fright when she removed the cannula! I did have to stop mtx to help with wound healing so worth checking whether you need to do that and how it'll affect your flare. To be honest, the enforced rest, sleep and time off work has helped my flare a bit. Everyone is different though. I agree that talking these issues through with your arthritis team would be best.

[lindyloo2018 in reply to RainbowLeopard]

ok thanks, what surgery did you have, mine is wrist as well..

[RainbowLeopard in reply to lindyloo2018]

I had a slow growing tumour removed from my palm.

[lindyloo2018 in reply to RainbowLeopard]

wow, hope that has gone now, how long did you have to stop mtx for ?

[RainbowLeopard in reply to lindyloo2018]

I was advised to stop the week before surgery and the week after. I'm tempted to miss it again this week and the wound hasn't healed yet (but then mtx makes me nauseous so I'm always looking for excuses not to take it!)

[lindyloo2018 in reply to RainbowLeopard]

if the flare is hindering your wound healing stopping mtx might not be such a good idea. I would get the hospital/RA nurses to check it out in case it needs antibiotics..

[RainbowLeopard in reply to lindyloo2018]

thank you. Hope your op goes well!

[oldtimer2]

I had a vaginal repair in the early stages of a severe flare. The anaethesthetic consultant was very helpful and actually got me almost pain free post-operatively - although I was definitely high, easily tearful and giggly. It's just another problem to be overcome - possible but not ideal.

You're right that the operation will increase your inflammatory reponse and this needs to be allowed for. The fact that both consultant teams are saying ask the other one means they don't know the answer. I'd get on with it personally but it's your body and you know how important the surgery is to you.

[Portinatx17]

I had a knee replacement in the middle of a flare. Strangely enough, my flare evaporated post op but came back with avengeance after 4 wks. I was ok to still take Methotrexate but had to stop Amgevita inj for 4 wks pre op. Every surgeon has different views on this though. Good luck x

[Runrig01]

I’m having foot surgery in just over a week. I have ankylosing spondylitis, which as well as my spine, affects nearly every joint in my body. I have had a chest infection in Dec that didn’t resolve, so needed a second course of antibiotics. It meant being off my MTX and benepali for 3 weeks, and put me in a flare. I’m now off benepali for at least 4 weeks, depending on wound healing, and I’ll miss 2 weeks of MTX as well. My rheumatologist is happy for me to proceed with surgery. It’s my left foot, I’m having done, but my right leg is the worst at the moment. Hoping that settles a bit, so I can mobilise, even if only to the loo. Hope things go well for you 🤗