Perioperative Managment

The updated guidelines list disease modifying anti-rheumatic drugs (DMARDs) and biologics with commentary on the dosing interval and also the recommended timing of surgery relative to last medication dose. New medications that have been added to the guidelines since 2017 are anifrolumab, voclosporin, ixekizumab, guselkumab, baricitinib, upadacitinib. The guidelines for rituximab, belimumab, apremilast, and JAK inhibitors have also been updated since 2017. The new guidelines have been visually presented in the infographic above.

Of note, the guidelines include recommendations depending on severity of systemic lupus erythematous (SLE). Severe SLE has been defined by the guidelines as an organ threatening disease. This has been done to help balance the risks of infection with those of an SLE flare.