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World J Orthop. Jan 18, 2014; 5(1): 38-44
Published online Jan 18, 2014. doi: 10.5312/wjo.v5.i1.38
Orthopedic surgery and its complication in systemic lupus erythematosus
Anselm Mak
Anselm Mak, Division of Rheumatology, Department of Medicine, University Medicine Cluster, Singapore 119228, Singapore
Anselm Mak, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Author contributions: Mak A solely wrote this manuscript.
Correspondence to: Anselm Mak, MMedSc, MBBS, MD, FRCP Edin, Division of Rheumatology, Department of Medicine, University Medicine Cluster, 1E Kent Ridge Road, Level 10, NUHS Tower Block, Singapore 119228, Singapore. mdcam@nus.edu.sg
Telephone: +65-67-795555 Fax: +65-67-724119
Received: August 29, 2013
Revised: September 29, 2013
Accepted: October 18, 2013
Published online: January 18, 2014
Processing time: 144 Days and 10.1 Hours
Abstract

Systemic lupus erythematosus (SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of internal medicine, patients with SLE often present with signs and symptoms pertaining to the territory of orthopedic surgery such as tendon rupture, carpal tunnel syndrome, osteonecrosis, osteoporotic fracture and infection including septic arthritis, osteomyelitis and spondylodiscitis. While these orthopedic-related conditions are often debilitating in patients with SLE which necessitate management by orthopedic specialists, a high index of suspicion is necessary in diagnosing these conditions early because lupus patients with potentially severe orthopedic conditions such as osteomyelitis frequently present with mild symptoms and subtle signs such as low grade fever, mild hip pain and back tenderness. Additionally, even if these orthopedic conditions can be recognized, complications as a result of surgical procedures are indeed not uncommon. SLE per se and its various associated pharmacological treatments may pose lupus patients to certain surgical risks if they are not properly attended to and managed prior to, during and after surgery. Concerted effort of management and effective communication among orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care.

Keywords: Orthopedics; Complications; Surgery; Systemic lupus erythematosus; Operation

Core tip: Systemic lupus erythematosus (SLE) is a complex autoimmune condition. Orthopedic specialists often encounter patients with SLE presenting with various orthopedic conditions which require surgical intervention but due to the complexity of SLE and its associated treatment, pre-operative preparation and post-operative care for these patients are often challenging. Concerted effort of management and effective communication between orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care.