Elia CJ, Brazdzionis J, Toor H, et al. - A multi-centered retrospective review from five institutions was designed to ascertain if continuing or withholding disease-modifying antirheumatoid drugs (DMARDs) in the perioperative period influence outcomes in rheumatoid arthritis (RA) patients undergoing arthrodesis at the craniovertebral junction. Researchers distinguished adult patients with RA on chronic DMARDs undergoing posterior arthrodesis of the craniovertebral junction (occipital-cervical or atlanto-axial arthrodesis). The primary endpoint included the requirement for reoperation and reason for reoperation. Study included a total of 39 individuals, 19 in C group and 20 in DC group (average follow-up time was 42 months). The cohort of RA patients who had undergone occipital-cervical and C1/C2 posterior arthrodesis exhibited no significant differences in surgical complications when DMARD therapy was continued or discontinued in the perioperative period. In the perioperative period, the decision to continue or discontinue DMARD therapy is at the discretion of the treating physician, but they appreciate physicians to counsel patients regarding this theoretical risk and their tolerance of the medications as well as the risk of RA flare-up. It was shown that factors such as overall health, disease burden, nutrition, bone quality, smoking status, and other comorbid conditions are likely to have a larger affect on perioperative complications.