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Best of 2025: Variability of Guidelines on the Perioperative Use of DMARDs in Rheumatic Diseases Patients

Jack Cush, MD

More effective treatments in patients with rheumatic diseases have resulted in less need for major surgery, yet a substantial number of RMD patients will undergo surgery often in the setting of DMARDs use. A scoping review looked at numerous clinical practice guidelines/recommendations for the perioperative management of DMARDs and found inconsistencies and low quality evidence, with great reliance on conditional (expert opinion) recommendations.

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APP Pearls “When I’m explaining treatment options, I say “hey you are the captain of this ship, I’m your co-captain. I help to guide you along this journey… (I can help you) avoid that Hurricane.” - April Woodrow, APRN, ANP-BC

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APP Pearls “Steroids are not a long-term plan; AND One visit cannot fix everything” - Claudia Rivera-Salas, NP

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APP Pearls “Get to know your patients and any barriers they have that may impact their healthcare” - Natalie Lane, FNP-C

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APP Pearls “When seeing a new patient, never assume that their preconceived or prior diagnosis is the only rheumatology condition that they have” - Lindsay Tom, PA-C

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APP Pearls “Point out to every patient with gout that poorly controlled gout will increase their risk of CV events and mortality” - Emma Bavage, NP

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Algorithm for the treatment of calcinosis #calcinosis #ACR24 https://t.co/NZhP7Enzrp https://t.co/I0HLtYjzgb

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Intro to ILD (Part I): the essentials 🫁 Definition & basics 🔬 Key pathology patterns 🧑⚕️ Clinical approach 📋 What rheums need to know ⬇️ Download & learn more: https://t.co/Fn76PiGsPl Created by @MithuRheum | via @RheumNow for our Rheum to Breathe: ILD Campaign https://t.co/JpyE3T7Atj

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APP Pearls “Do not order a test if you do not know how to interpret the results whether normal or abnormal” - Madison Chastain, CRNP

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APP Pearls “Never stop learning—rheumatology is full of surprises” - Kayla Carlucci, FNP-BC

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Three Things to Know About Hiring, Onboarding, and Training APPs As the utilization of APPs (nurse practitioners and physician assistants) in rheumatology becomes more prevalent, here are three things to consider if you are thinking about adding an APP to your practice: Read https://t.co/24RVd09vcK
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APP Controversies and Misconceptions In this Tuesday Night Rheumatology, panelists discuss a range of topics, including APP roles and impact; models of care; independence; seeing new patients and complex cases; and more. Panelists: Daric A. Mueller, PA-C; Lisa Carnago, PhD, https://t.co/t2PssfUNoV
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APP Pearls “You must assess sleep and mood- without this, even if you control all inflammation, you will not control pain and fatigue!” - Christine Stamatos, NP, DNP, RN

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Tricks of the Trade – Clinic Advice from APPs December 2025 is focused on advanced practice providers, their impact, education and priorities. In seeking and soliciting the help and advice of leaders in the rheumatology APP world, I have been impressed by APP pride, dedication https://t.co/boyjytkUyq
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Hidden in Plain Sight: IBD As a PA with six years of experience in rheumatology and a background in gastroenterology, today I'm discussing the clinical overlap between inflammatory arthritis—particularly psoriatic arthritis and spondyloarthropathies—and inflammatory bowel https://t.co/Aatc4jkbpH
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Antinuclear Antibodies (ANA) https://t.co/xERp8kev1T https://t.co/e3psPC7HIl

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NPs and PAs: Opportunities Outside of the Exam Room Ben Smith, PA-C, Thomasville, GA, discusses scholarly and leadership opportunities for nurse practitioners and physician assistants, as part of RheumNow's "Mission: APP Partners in Care" campaign during the month of December. https://t.co/Vzx6B1z2xJ
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Evaluation of Rheumatic Complaints https://t.co/cdizOgFqYf https://t.co/YHLAllxpO4

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ACR: New Data Highlights Urgent Need to Address Arthritis Burden New findings from national U.S. surveys reveal the profound impact of arthritis on millions of adults, especially those facing social and economic challenges. These data will be featured in an upcoming issue of https://t.co/3LlNQ3tx90
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Role of the Nurse in the Care and Management of Rheumatic Diseases - EULAR Review In 2023, a EULAR subcommittee evaluated the roles of nurses and Advanced Practice Nurses (APNs) in arthritis care per EULAR guidelines. Initially proposed in 2012 and revised in 2018, the scope of https://t.co/w1IOQxcACR
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