How long should tsDMARDs be held before surgery?

• A. 1 day before surgery
• B. 4 days before surgery
• C. 2 weeks before surgery
• D. 1 month before surgery

Answer: (B)

Holding tsDMARDs for about four days before planned surgery is used to balance reducing infection risk and avoiding a disease flare. These drugs suppress immune signaling, which can impair wound healing and increase postoperative infection risk. Giving a four-day washout lets drug levels drop and immune function begin to recover by the time of surgery, while not delaying the operation longer than necessary. Shorter hold times (like one day) may not be enough to mitigate perioperative immunosuppression, and much longer holds (weeks to a month) risk a painful flare of the underlying disease. After surgery, restart is decided based on wound healing and infection risk, in coordination with the surgical and rheumatology team.