Corticosteroids are widely used drugs for the initial treatment and exacerbations of rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus and rheumatic polymyalgia.
Should I suspend corticosteroids before surgery?
Corticosteroids have an important modulating effect on the immune system, but they are also part of the complex mechanism that regulates the response of the human body to stress, which can be precisely represented by surgery. Although the risk of infection increases, it is important not to suspend corticosteroids before surgery, especially if treatment has been started for a long time. On the contrary, it may be necessary to increase the daily dosage of cortisone to reduce the risk of exacerbation of rheumatic disease and to avoid a serious complication represented by the “adrenal crisis” caused by sudden suspension of cortisone in our body. In special cases, such as if the patient is taking 5 mg or less of cortisone and has to undergo short-term surgery that does not require hospitalization, it may not be necessary to increase the daily steroid dosage.
In general, it is important to remember that a patient with rheumatic disease on cortisone therapy still has an increased infectious risk, about 13 times, compared to the general population. If you plan to schedule a surgical operation, it is important to talk to the rheumatologist to decide if and how you want to modify your cortisone therapy in anticipation of surgery.
Jacobs A.M., Perioperative Management of the patient with Rheumatoid Arthritis, 2010. Clin Podiatr Med Surg.