At 26, why do my IBS M symptoms worsen in public?

Question

Hello, Doctor,

I am 51 years old and have been living with rheumatoid arthritis (RA) for many years. I am currently on Methotrexate and biologic therapy. Even small cuts take a long time to heal and surgeries worry me. Last time, stitches healed very slowly. Inflammation is controlled, but the skin feels fragile. I don't want joint damage, but I also fear complications from delayed healing as I age. Please tell me,

Why do RA medications cause problems with wound healing at 51?
Is it immune suppression or poor circulation?
Should medicines be paused before procedures?
How do doctors balance infection risk vs flare risk?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Disease itself and the medications are the two main reasons for slow wound healing in rheumatoid arthritis (RA). The medications used to control RA, such as Methotrexate (an immunosuppressant drug) and biologics, work by suppressing specific parts of the immune system and cell growth. Unfortunately, these same processes are essential for normal wound healing.

Regarding surgical outcome, do not stop or pause your RA medications on your own. The decision to hold Methotrexate or biologics before a procedure must be made jointly by your rheumatologist and surgeon. The balance is delicate: stopping medications increases the risk of a painful and potentially damaging RA flare, while continuing them may slightly increase infection risk and delay healing.

General guidelines commonly followed by the doctors are,

Methotrexate is usually continued through surgery.
Biologics are typically stopped one to four weeks before surgery (depending on the specific drug) and restarted about 14 days after, once the wound is healing well and there is no sign of infection.
Leflunomide (a disease-modifying drug) has a stronger association with wound-healing complications and may require a washout procedure, though this is less common compared to Methotrexate.

You should do the following before any planned surgery,

Arrange a pre-operative assessment with your rheumatologist 4 to 6 weeks in advance.
Ensure coordination between your rheumatologist and surgeon to create a personalized medication hold plan.
Aim for low disease activity before surgery, as this improves healing outcomes.
Skin fragility is multifactorial. In addition to medications, long-standing RA can cause small-vessel inflammation and thinning of the skin, especially if corticosteroids have been used in the past.

Your concern is valid, but this is a common and well-managed situation. Rheumatologists routinely balance these risks. Always inform your surgeon about your medications, and never stop them without medical guidance.

I hope this information helps you.

Feel free to ask further queries.

Thank you.