When to pause arthritis medications before shoulder replacement surgery

This study is testing the best timing for pausing immunosuppressant medications — drugs that calm down an overactive immune system — before and after shoulder replacement surgery in people with rheumatic diseases like rheumatoid arthritis. Right now, doctors don't have clear guidelines for shoulder surgery the way they do for hip and knee surgery, so this trial will compare two different schedules: pausing the medication for a longer time versus a shorter time. The study will track whether differences in timing affect infection risk, wound healing, pain, function, and disease flares.

People with rheumatic diseases need to take immunosuppressant medications to manage their conditions, but these drugs can increase infection risk during surgery. While doctors have established guidelines for hip and knee surgery, there's uncertainty about the safest approach for shoulder replacement — specifically, how long to pause these medications before surgery and when to restart them afterward.