Morse KW, Heinz NK, Abolade JM, et al. - Researchers retrospectively examined prospectively collected cohort of patients with rheumatoid arthritis (RA) undergoing total joint arthroplasty (TJA). They collected disease activity measured by Clinical Disease Activity Index (CDAI), PROMs and serologies. They summarized and compared baseline characteristics. They obtained transfusion requirements and tranexamic Acid (TXA) usage from chart review. Using logistic regression, factors correlated with transfusion in RA patients undergoing TJA were ascertained. A total of 252 patients, mostly women with longstanding RA and end-stage arthritis requiring TJA were recruited in the study. The results exhibit that in RA individuals, pre-operative health optimization should include evaluation and treatment of anemia before TJA, as preoperative hemoglobin level is the main risk factor for post-operative transfusion. For post-operative transfusion , increased disease activity and increased surgical time were independent risk factors but are less modifiable. A prospective trial is required to validate this while TXA did not reduce transfusion risk in this population.