Morse KW, Heinz NK, Abolade JM, et al. - This study was intended to assess whether and how tranexamic acid does not reduce the risk of transfusion in rheumatoid arthritis patients undergoing total joint arthroplasty. In this study, data from a prospectively collected cohort of patients with rheumatoid arthritis (RA) undergoing total joint arthroplasty (TJA) were retrospectively examined. Researchers collected disease activity measured by Clinical Disease Activity Index, patient-reported outcome measures, and serologies. Baseline characteristics were summarized and compared. They obtained transfusion requirements and tranexamic acid (TXA) usage from chart review. Using logistic regression, factors associated with transfusion were ascertained in RA patients undergoing TJA. As preoperative hemoglobin level is the main risk factor for postoperative transfusion, in RA patients, preoperative health optimization should include assessment and treatment of anemia before TJA. It was shown that for postoperative transfusion, increased disease activity and increased surgical time were independent risk factors but are less modifiable. A prospective trial is needed to confirm this, while TXA did not decrease transfusion risk in this population.