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Methotrexate Perioperative Continuation — FRCA Final MCQ

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ModeratePerioperative MedicineMethotrexate Perioperative ContinuationFRCA Final

A 60-year-old man on methotrexate 15 mg weekly for rheumatoid arthritis requires elective knee replacement. How should methotrexate be managed perioperatively?

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Correct answer: DContinue methotrexate perioperatively

BSR/BHPR and RCOA guidelines recommend CONTINUING methotrexate perioperatively for elective orthopaedic surgery. Stopping increases RA flare risk without clearly reducing infection risk. This is supported by RCT evidence showing no increase in surgical site infections when methotrexate is continued.

Reference: BSR/BHPR – 2023 – Perioperative management of DMARDs; RCOA – 2023