Polyarthrite rhumatoïde, mise au point sur le traitement et prise en charge anesthésique

A diagnosis of rheumatoid arthritis carries with it a lifelong progressive disease; however, some patients enjoy periods of partial to total remission. The disease frequently plagues to small joints; extension to the cervical spine is especially a concern for anesthetists due to the risk of difficult intubation and neurological lesion related to C1-C2 subluxation. Treatments such as NSAID's and steroids convey a risk of complications such as infection but need to be continued or substituted. Methotrexate is also a risk factor of septical complication due to its immunosuppressive effect. Preoperative evaluation has to consider systemic complication that may interfere with anesthetic management such as pericarditis or interstitial pneumonia. Regional anesthetic techniques must be favored in as much as possible while a special attention must be paid to patient positioning during surgery to avoid painful discomfort. Postoperatively, it is critical to ensure adequate pain control and to maintain preoperative treatments.