Details
Category: Volume 05 Issue 08 August 2017
Hits: 1496

Title: Scheduling multiple surgical procedures in immunocompromised rheumatoid patient on immunosuppressant regimen

Authors: Areej Darraj, Khurshid A Mattoo, M. Nazish

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.139

Abstract

Rheumatoid arthritis is a disease that can be crippling as well as fatal. The use of disease modifying drugs (methotrexate) and biologic response modifiers (adalimubab) have helped in altering the history, course and fatality related to the disease. In advance stages, surgical intervention in the joints becomes a necessity and healing has been successfully accomplished by withholding the drugs for a period of 1 to 2 weeks depending upon the dose of the drugs. However, dental surgical procedures like multiple pulpectomy, multiple extractions and crown lengthening procedures have to be completed in several appointments that demand a different approach in such patients. This article presents a case report of a 23 year old female, with a history of rheumatoid arthritis under a prescribed medication regimen, who presented generalized gross rampant caries of the natural teeth that required full mouth rehabilitation.

Keywords: immunity, dental laser, crown lengthening, full mouth rehabilitation, endodontic.

References

  1. Galvin EM, O’Donnell D, Leonard IE – Rheumatoid arthritis: a significant but often underestimated risk factor for perioperative cardiac morbidity. Anesthesiology, 2005;103: 910-911.
  2. Goodson N – Coronary artery disease and rheumatoid arthritis. Curr Opin Rheumatol, 2002;14:115-120.
  3. Davies SF, Iber C – Obstructive sleep apnea associated with adult acquired micrognathia from rheumatoid arthritis. Am Rev Resp Dis, 1983;127:245-247.
  4. Lavie P, Nahir M, Lorber M et al. – Nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis patients. Lack of association between clinical improvement and effects on sleep. Arthritis Rheum, 1991;34:655-659.
  5. Gordon DA, Stein JL, Broder I – The extra-articular features of rheumatoid arthritis. A systematic analysis of 127 cases. Am J Med, 1973; 54:445-452.
  6. Kremer JM, Weinblatt ME, Bankhurst AD, Bulpitt KJ, Fleischmann RM, Jackson CG, et al. Etanercept added to background methotrexate therapy in patients with rheumatoid arthritis: continued observations. Arthritis Rheum. 2003 Jun; 48 (6): 1493-9.
  7. Gardner DL, Holmes F – Anaesthetic and postoperative hazards in rheumatoid arthritis. Br J Anaesth, 1961;33:258-264.
  8. Cronstein BN (2005) Low-dose methotrexate: a mainstay in the treatment of rheumatoid arthritis. Pharmacol Rev 57:163–172 
  9. Grennan DM, Gray J, Loudon, J, Fear S (2001) Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Ann Rheum Dis 60:214–217
  10. Sany J, Anaya JM, Canovas F et al (1993) Influence of methotrexate on the frequency of postoperative infectious complications in patients with rheumatoid arthritis. J Rheumatol 20:1129–1132
  11. Carpenter MT, West SG, Vogelgesang SA, Casey Jones DE (1996) Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy. Orthopedics 19:207–210
  12. Bibbo C, Anderson RB, Davis WH, Norton J (2003) The influence of rheumatoid chemotherapy, age, and presence of rheumatoid nodules on postoperative complications in rheumatoid foot and ankle surgery: analysis of 725 procedures in 104 patients. Foot Ankle Int 24:40–44
  13. Lisowska B, Rutkowska-Sak L, Maldyk P et al. – Anaesthesiological problems in patients with rheumatoid arthritis undergoing orthopaedic surgeries. Clin Rheumatol, 2008;27:553-556.
  14. Skues MA, Welchew EA – Anaesthesia and rheumatoid arthritis. Anaesthesia, 1993;48;989-997.

Corresponding Author

Khurshid A Mattoo

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.