Table 3 Disease-specific complications that may affect use of analgesia and anesthesia

Systemic lupus erythematosus

Pericarditis or valvular abnormalities

Pulmonary hypertension, pleural effusions, or lupus pneumonitis

Peripheral neuropathies, central nervous system dysfunction (seizures), or psychological problems

Hematological abnormalities (anemia, thrombocytopenia, or coagulopathy)

Lupus nephritis

Antiphospholipid syndrome

Coexisting autoimmune disease, secondary organ involvement, and thrombotic phenomena, including pulmonary

hypertension

Anticoagulation

Rheumatoid arthritis

Cervical spine involvement (exclude atlantoaxial anterior subluxation and avoid excessive manipulation of neck during general anesthesia)

Hip disease that might prevent vaginal delivery

Pleural/pericardial effusions and pulmonary parenchymal involvement

Ankylosing spondylitis

Assess presence of extra-articular (cardiopulmonary) features and use of opiate analgesics

Temporo-mandibular joint dysfunction, cervical and lumbar spine (for general, epidural, or spinal anesthesia), and hip

involvement (for vaginal delivery)

Systemic sclerosis

Renal disease, systemic hypertension, pulmonary hypertension, or cardiac dysfunction

Assess peripheral pulses, peripheral venous access, extent of Raynaud phenomenon, and skin involvement

Vasculitis

Organ ischemia (cardiac, renal, cerebral, and limb) and intravascular volume

Monitor hypertension and end organ complications or thrombosis