In order to minimize the risks of infection and other potential complications with podiatric surgery in this patient population, this author reviews the literature and offers insights on whether medications for RA should be withdrawn, continued or modified during the perioperative period. Increasingly, the treatment of rheumatoid arthritis includes the utilization of immunosuppressive therapeutic agents. Bull's eye maculopathy hydroxychloroquine Plaquenil retinal screening Leflunomide Arava is an older DMARD that helps reduce pain and swelling due to RA. It may be given in addition to methotrexate, if methotrexate alone is inadequate to control the progression of RA. Sulfasalazine is a combination of sulfapyridine and aspirin like compounds. The medication may be associated with diminution in complete blood cell count. In general, one should consider withdrawal of the medication three or four days prior to surgery. Hydroxychloroquine is a less commonly utilized disease modifying anti-rheumatic medication. Background/Purpose The combination of methotrexate MTX, sulfasalazine SSZ and hydroxychloroquine HCQ triple therapy is a highly effective and well-tolerated treatment in rheumatoid arthritis RA. While MTX is the cornerstone of most successful combination therapies, not all patients are candidates for, or tolerate, MTX. Leflunomide, a disease-modifying anti-rheumatic drug DMARD. Louie and Ward demonstrated that in the state of California, rates of joint surgery for the treatment of RA declined in the 1990s and have continually diminished since that time.1 The authors concluded that the favorable long-term outcomes for the treatment of rheumatoid arthritis with newer agents have resulted in a decreased need for bone and joint surgery in patients afflicted with this disease. The effectiveness of disease modifying agents in reversing the progression of rheumatoid arthritis (RA) is illustrated by the reduced frequency with which patients with RA undergo surgery for bone and joint deformities. Methotrexate sulfasalazine hydroxychloroquine and leflunomide DMARDs A Treatment Option for RA Everyday Health, A Guide To Perioperative Management Of The Rheumatoid Patient. Does plaquenil affect the brain fogNormal dosage for plaquenilChloroquine ocular side effectsHow does plaquenil help with fatiguePlaquenil mouth ulcers Conventional DMARDs that have been paired with methotrexate include sulfasalazine, hydroxychloroquine, cyclosporine, leflunomide and azathioprine. Although studies of these combinations have shown differing levels of benefit, the combinations of methotrexate plus leflunomide and methotrexate plus sulfasalazine are among the most effective. DMARDs Arthritis Foundation. Leflunomide, Sulfasalazine and Hydroxychloroquine for.. Leflunomide vs methotrexate - Answers on HealthTap. Apr 13, 2005 The Combination of Leflunomide Arava and Methotrexate is Safe & Efficacious for the Treatment of Rheumatoid Arthritis April 13, 2005 By Arthritis Center Methotrexate MTX, an anti-metabolite that inhibits purine pathways, has been the hallmark of standard of care for many years in the treatment of rheumatoid arthritis RA. Objective To determine the survival and clinical effectiveness of leflunomide LEF compared with methotrexate MTX and sulfasalazine SSZ for RA in an observational study. Methods An observational database of 1088 patients and 5141 patient years. A 44-year-old woman with seropositive rheumatoid arthritis, on triple-DMARD therapy methotrexate, sulfasalazine, and hydroxychloroquine, presents with a 1.5-cm nodule on her right breast, and no suspicious regional lymph nodes.