What do I need to know if I am planning for surgery and I have lupus?
Dr. Thomas is author of the book, “The Lupus Encyclopedia”, and a practicing rheumatologist in Greenbelt, Maryland.
Dr. Thomas is author of the book, “The Lupus Encyclopedia”, and a practicing rheumatologist in Greenbelt, Maryland.See all of Donald E. Thomas, Jr., M.D., FACP, FACR, CCD's answers.
It is important to have ongoing communication with your healthcare provider about the risks of surgery with lupus, especially as it relates to stopping any of your lupus medications. When planning for surgery, there are several important things to keep in mind:
- Call and see your rheumatologist ASAP when you know that a surgery is needed. If the surgery can be delayed (this is often called elective surgery), it is best to plan well ahead of time. Surgery may induce a lupus flare or may cause complications if surgery is performed while having a flare, so it's important to know the status of your lupus before having a procedure. Additionally, some people with lupus may have problems with wound healing, especially if they have vasculitis (inflammation of the blood vessels) that affects the skin, or if they are at an increased risk of developing infections because of lupus. Certain lupus medications (for example, prednisone or other corticosteroids) can also impair wound healing, making the recovery process challenging. Platelet counts, the use of other immune suppressant medicines, active infection and blood clotting problems should be discussed thoroughly with the healthcare provider treating your lupus as well as your surgeon before undergoing surgery.
- Ask your rheumatologist to communicate with your surgeon regarding what needs to be done about your medicines. Ask your rheumatologist if and when each of your medicines needs to be stopped before surgery and when they can be restarted. If you have been on steroids, it will be important to know if your dose of steroids needs to be increased around the time of surgery (often called "stress doses" of steroids). If you are taking any over the counter supplements (such as ginger, garlic, St. John’s wort, etc.), most of these should be stopped one week before surgery, since many of these can interfere with bleeding and with the anesthetic medicines.
- If you have any significant organ involvement (kidney, lung, heart); make sure to see the corresponding specialist (for example, a nephrologist, pulmonologist, cardiologist, etc.) to also communicate recommendations to your surgeon.
- If you have dryness from Sjogren's syndrome or if you have Raynaud's phenomenon, make sure to ask your rheumatologist to provide specific recommendations to your surgical team about what measures should be taken in order to not worsen these problems around the time of surgery.
Medically reviewed on June 12, 2014