Периоперационное ведение больных ревматоидным артритом

В статье рассматриваются рекомендации по совместному ведению больных ревматоидным артритом, нуждающихся в эндопротезировании крупных суставов нижних конечностей, ревматологами и травматологами-ортопедами. В связи с отсутствием общепринятых стандартов и рекомендаций по периоперативному ведению больных с ревматическими заболеваниями, принятых международными ревматологическими ассоциациями, в статье обобщен собственный опыт ведения пациентов с учетом международных подходов и рекомендаций разных стран. Обсуждаются подходы к оценке и снижению рисков кардиоваскулярной патологии, профилактики инфекционных осложнений, кровотечений, тромбозов глубоких вен нижних конечностей, особенности ведения больных с остеопорозом. Подробно представлен опыт ведения больных, получающих антиревматическую терапию нестероидными противовоспалительными препаратами, базисными противовоспалительными препаратами: метотрексатом, лефлуномидом, сульфасалазином, гидроксихлорохином. Даются рекомендации по ведению больных, получающих глюкокортикоиды и генно-инженерные биологические препараты (ингибиторы фактора некроза опухоли α, анти-В-клеточную терапию и ингибиторы рецепторов интерлейкина 6), в предоперационном и послеоперационном периоде.

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