MTX - surgery question

agslegs
agslegs Member Posts: 28
edited 8. Oct 2011, 07:50 in Living with Arthritis archive
Hello

I am due to have surgery in the next few weeks. The surgery is not related to my RA. Anyway I am currently on 15mg of MTX which I take once a week. My RA is moderately controlled as my inflammation markers are high but not sky high as before.

My surgeon has told me that he wants me to come off MTX for 4 weeks prior to surgery. I mentioned this to my Rheummy consultant who said there is no need for me to come off my meds and I should stay on them as there is no reason why I should risk having a flare. So who to believe. :roll: Both men are consultants and I am stuck in the middle. It is major surgery and I will be in hospital for 5 days and will then need 10 weeks off work.

Have any of you been through this dilemma? :?: Should I speak to my GP?

agslegs

Comments

  • lindalegs
    lindalegs Member Posts: 5,398
    edited 30. Nov -1, 00:00
    Yes I've been through this recently.

    My Rheumy said there was no need to stop Mtx and the surgeon said come off it a week before the op. I told the surgeon what the consultant said and the surgeon said it was up to me if I stopped it or not.

    I didn't take the dose the day before my operation.

    I think you ought to tell the surgeon what your rheumy says because it depends on what operation you're having and whether there's an increased risk of infection.

    Hope this helps.
    Love, Legs x
    'Make a life out of what you have, not what you're missing'
  • valval
    valval Member Posts: 14,911
    edited 30. Nov -1, 00:00
    hi can not help but wanted to bump it back to top
    val
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
    As methotrexate is an immuno-suppressant I think surgeons prefer you not to be on it to minimise the risk of post-op infection. As rheumatologists do not perform surgery (well, not as far as I know) though they may be aware of this they won't be that concerned by it. It is possibly a clash of cultures. I would always follow the advice of the surgeon - meth takes a while to leave one's system, you may well be a little more vulnerable to infection as a result of taking it, but you will be in the right place to be 'dealt' with should summat nasty result.

    Whatever the op, I wish you well and I hope it helps matters. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • lindalegs
    lindalegs Member Posts: 5,398
    edited 30. Nov -1, 00:00
    In my case, the surgeon said he would follow the advice of the rheumatologist ................it's still worth letting him know what your Rheumy said IMO.
    Love, Legs x
    'Make a life out of what you have, not what you're missing'
  • mp1952
    mp1952 Member Posts: 425
    edited 30. Nov -1, 00:00
    Hi

    Just to say that my orthopaedic surgeon told me to Stay on the mtx when i had my hip replaced last year. I did, and was fine.

    It does seem to vary from one consultant to another though!!

    Marion
  • agslegs
    agslegs Member Posts: 28
    edited 30. Nov -1, 00:00
    Hello

    Thank you for your replies. It is so confusing. My gynea has been away this week but back on Monday. I think I will get a date for the surgery then. I will then have a chat with him again and will see what he thinks about what is best to do about the Mtx. Coming off it for 4 weeks prior to surgery does sound excessive but perhaps we can go half way and I can stop it for a couple of weeks. My health is not the best and I just want the best for me. I will continue asking questions of my consultants.

    agslegs
  • skezier
    skezier Member Posts: 11,333
    edited 30. Nov -1, 00:00
    hi agslegs,

    welcome from me as well and sorry i am doing the one handed typing.

    the trouble with the mtx is also that it can retard healing.... i think most advise to come off it and for this one i would go with the surgeon more than the rumo but gt back on it as soon as the wound has healed.....

    saying that the 2 consultants should really talk to each other and make a joint decision.... i hope thats what they will do. nice to meet you, cris x
  • stickywicket
    stickywicket Member Posts: 27,764
    edited 30. Nov -1, 00:00
    For me, it’s always been the surgeon who makes the decision not the rheumatologist.

    When I had a THR, about 6-7 years ago, he told me to lay off the methotrexate for about 6 weeks beforehand and a few after. I was pleasantly surprised at how well I lasted without it but, having said that, I was mostly just trundling about the house in a wheelchair at the time as the hip was totally shot.

    When I had a knee revision, with bone grafts, two years ago the same surgeon said to just leave off the methotrexate the week before & after the op. He said they’d now decided it didn’t make any difference to the outcome. (Mine’s a big teaching hospital and they’re pretty much on the ball with stuff.)

    I was on about 20 mgs at the time. Whatever yours decides try not to worry about the decision.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright

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