surgery and MTX | Arthritis Information

Hello again,

Following my triplet pregnancy, my stomach is in need of some serious nip-tuck. I went to
see the plastic surgeon yesterday to discuss a tummy tuck. While going over my medical history, the plstic surgeon
said he was scared of the meds that I take. He said that certain meds scare him and that
MTX and plaqunil and ketoprofene were among them. He said that because these drug supress my
immune systeme, I will be more vulnerable to post-operative infections and that I will not heal
as well as I should. I was shocked. I have had several surgeries while on DMARDS (gold). Also,
my C-section was done while I was on plaquenil and sulfasalisine as well as anti-inflammatory.
He mentionned that anti-inflammatories are a no-no because patients bleed to much (this I can
understand however).

I had seen another plastic surgeon a few days before and he did not seem concerned at all.
He did not even mention that I will need to stop the meds. However, the other doctor said that he
will not operate on me if I do not stop the meds. He asked my if they were really necessary
(huh...YEAH!!) and what will happen if I stop. He wants me to talk to my rheumy and wants my rheumy
to put something in writing saying that I need to stop for X amount of weeks pre-op and X amount
of weeks post-op. it seems to me that the plastic surgeon just wants to be able to exonerate
himself if something should go wrong. I seriously dount that my rheumy will want to put
something in writing!!!

Any of you have any experience in surgeries and DMARDS? And what was recommended? The
plastic surgeon was going on and on about the fact that the surgery was lective and
that he could not justify operating in less than optimal conditions given the optional
nature of the surgey.

I have had multiple surgeries while on meds. I am actually having bilateral jaw surgery on Wed. My rheumy had me move up my Rituxan infusion and I stop the MTX the week before and the week after. When I have had emergency surgery, I haven't stopped the MTX since there wasn't time.

But when we were trying to conceive, I had to stop MTX for three months before we could even start trying. I thought maybe I would have to stop for the same amount of time. Wouldnt all the MTX have to be out of my system otherwise I would still have a higher risk of infection?

When I was told I needed a hysterectomy (ended up not having it though) I asked my doctor about the mtx and surgery and she said to be off of it for a week prior to surgery and then back on it a couple weeks after.

Good luck with the tummy tuck..I had one about 17-18 yrs ago. I didn't have RA at that time (well..wasn't diagnosed at that time) it was right after the surgery that I was having pain that sent me to my doctor and then after bloodwork, was told I had RA.

I'm sure you'll be happy with your tummy tuck!

Kelly

The usual medical response to dmards and biologics is that you should not take them for 1-2 weeks prior to surgery and not restart for 1-2 weeks after surgery. This is a general consensus but there are doctors who don't advise their patients to stop and start and for the most part the patients do fine but there is a number of patients who don't and I wouldn't be willing to take that chance.

Your plastic surgeon is being cautious and I don't blame him. He doesn't want post op complications that could have been prevented by stopping the meds. Most likely your RD is going to tell you the same thing. Call your RD and talk to him/her before you make any decisions about surgery.

I've had 4 surgeries, 3 minor, 1 major (knee replacement) and each time my RD and surgeon advised that I stop the meds 1 week prior for the minor and restart 1 week after surgery and for the knee replacement I stopped meds 3 weeks prior and restarted 3 weeks after.

"The plastic surgeon was going on and on about the fact that the surgery was lective and that he could not justify operating in less than optimal conditions given the optional nature of the surgey."

I think he's being cautious and careful and has a right to be that way and not rush you into surgery without consulting your RD and reaching an agreement regarding your meds and how they'll affect the surgical intervention. Hope it all works out for you. Take care. Lindy

I've had three joint surgeries including metatarsal surgery with pins in my feet for six weeks, and never got an infection. Prior to each surgery I stopped MTX, Enbrel and any NSAIDS for a week. To deal with the pain, my RD recommended Vicodin which has codeine and acetominophin, no blood thinning NSAIDs.

I'm jealous of your tummy tuck! Enjoy the results and good luck to you.
I've had 4 minor surgeries in the past 5 years. Each time it was the same: Get off the DMARDS 1 week before and start up again 1 week after surgery. NSAIDS, including Ketoprofen, I was to get off them at LEAST 2 weeks prior to surgery and could resume after surgery assuming I was not taking other pain meds they gave me in the hospital.

Note that if you are taking Celebrex you can, in many cases, continue taking this drug throughout.