Anesthesic Management of a Patient Presenting a Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic disease that progresses in relapses and remissions. The disease affects preferentially the small joints but an extension to the cervical spine poses a particular problem for anaesthesia because of the risk of difficult and/or dangerous intubation due to the aggravation of neurological lesions linked to the occurrence of subluxation of the axis on the atlas. Treatments such as Non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids should be considered perioperatively, as it is important not to discontinue them, knowing that they increase the risk of sepsis as do other treatments (methotrexate) which have an immunosuppressive effect. The pre-anaesthetic evaluation of patients must also look for systemic damage (pericarditis, chronic interstitial lung disease) likely to interfere with the anaesthetic management. The latter must favour, as far as possible, loco-regional anaesthesia. Intubation through a fibrocope is the least traumatic technique. Taking care of the discomfort of the installation on a table, which is particularly harmful to these patients, and programming a multimodal analgesia as well as the continuation of treatment of RA.