Autoimmune & Connective Tissue

Dental Management of Patients with Rheumatoid arthritis

Rheumatoid arthritis — positioning & therapy review

Rheumatoid arthritis patients are frequently on corticosteroids, methotrexate and/or biologics (infection and stress-dose considerations). Cervical involvement can cause atlanto-axial instability, and TMJ/hand involvement affects positioning and home care.

Emergency vs routine management

Clinical precautions

• • Caution with neck extension — possible atlanto-axial instability; avoid forced positioning and prolonged supine time
• • Short appointments; support the TMJ if involved; adapted oral-hygiene aids for hand deformity
• • Assess for secondary Sjögren's (dry mouth) — caries and candidiasis risk
• • Review current corticosteroid / methotrexate / biologic therapy
• • Consider stress-dose steroids for major surgery (see the steroid-cover note)
• • Meticulous infection control

Information & tests to request

• • Daily prednisolone-equivalent dose (mg) — This patient's condition/therapy is commonly associated with long-term corticosteroids, which can suppress the adrenal response to surgical stress. Enter the daily dose (0 if none) to determine whether supplementary stress-dose cover is needed.

At a glance by procedure

Initial assessment before lab results or timing details are entered.

References

1. Autoimmune / connective tissue disease — dental management
2. Little JW, Miller CS et al. Dental Management of the Medically Compromised Patient, 10th ed., Elsevier 2023

Related guides

This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.