Disease-modifying antirheumatic drugs (DMARDs) have become essential treatments 
in the management of patients with inflammatory rheumatic diseases. Their use 
has resulted in a marked improvement of disease control and a limitation of 
joint damage, although some patients still require subsequent corrective or 
joint replacement surgery. Due to their immunosuppressive effects, some DMARDs 
are associated with an increased risk of infection. The aim of this review is to 
discuss the available literature on the management of DMARDs during the 
perioperative period, particularly in the case of orthopaedic surgery. 
Conventional synthetic DMARDs such as methotrexate, sulfasalazine, leflunomide, 
hydroxychloroquine appear to be safe during the perioperative period. 
Conflicting results on biological DMARDs, mainly tumour necrosis factor 
antagonists, are reported in the literature, including both increased and 
unchanged risk of superimposed infections after surgery. Taking into account the 
available literature, we included some propositions for the management of 
patients who will undergo surgical interventions.