Rheumatoid arthritis (RA) is a disorder of uncertain etiology characterized by immune-mediated chronic inflammatory synovitis, joint effusion, and synovial proliferation showing a prolonged course of repeating remission and exacerbation periods. 1 McCarthy DJ Pathology of rheumatoid arthritis and allied disorders. in: ed 11. Arthritis and Allied Conditions. Lea & Febiger, Philadelphia, PA1989: 647 Google Scholar The progression of RA affects many peripheral joints, especially those in the hands and feet, cervical spine, knees, and hips, manifesting as joint destruction, deformity, and/or ankylosis. Synovectomy and/or artificial joint replacement surgery is often performed for the relief of articular pain and functional joint disorders. Of these, peripheral articular manifestations on the cervical spine, cricoarytenoid joint, and temporomandibular joint (TMJ) are the most vexing problems for anesthesiologists. The restricted neck flexion and extension, increased risk of cord compression, 2 MacKenzie CR Sharrock NE Perioperative medical considerations in patients with rheumatoid arthritis. Rheum Dis Clin North Am. 1998; 24: 1 Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar narrowed glottic aperture, 3 Bridger MW Jahn AF van Nostrand AW Laryngeal rheumatoid arthritis. Laryngoscope. 1980; 90: 296 Crossref PubMed Scopus (43) Google Scholar increased risk of laryngeal upper airway obstruction, 4 Leicht MJ Harrington TM Davis DE Cricoarytenoid arthritis: A cause of laryngeal obstruction. Ann Emerg Med. 1987; 16: 885 Abstract Full Text PDF PubMed Scopus (31) Google Scholar , 5 Bamshad M Rosa U Padda G et al. Acute upper airway obstruction in rheumatoid arthritis of the cricoarytenoid joints. South Med J. 1989; 82: 507 Crossref PubMed Scopus (19) Google Scholar restricted mouth opening, and acquired retrognathia 6 Skues MA Welchew EA Anaesthesia and rheumatoid arthritis. Anaesthesia. 1993; 48: 989 Crossref PubMed Scopus (35) Google Scholar can be potential hazards for general anesthesia, because of the difficulty in airway maintenance by a face mask and in conventional endotracheal intubation using direct laryngoscopy. The extra-articular manifestations of RA, such as pericardial diseases, 6 Skues MA Welchew EA Anaesthesia and rheumatoid arthritis. Anaesthesia. 1993; 48: 989 Crossref PubMed Scopus (35) Google Scholar , 7 Khanam T Anaesthetic risks in rheumatoid arthritis. Br J Hosp Med. 1994; 52: 320 PubMed Google Scholar restrictive and/or obstructive pulmonary disorders, 6 Skues MA Welchew EA Anaesthesia and rheumatoid arthritis. Anaesthesia. 1993; 48: 989 Crossref PubMed Scopus (35) Google Scholar , 7 Khanam T Anaesthetic risks in rheumatoid arthritis. Br J Hosp Med. 1994; 52: 320 PubMed Google Scholar neurologic symptoms, 8 Lyssy KJ Escalante A Perioperative management of rheumatoid arthritis: Areas of concern for primary care physicians. Postgrad Med. 1996; 99: 191 PubMed Google Scholar anemia, 6 Skues MA Welchew EA Anaesthesia and rheumatoid arthritis. Anaesthesia. 1993; 48: 989 Crossref PubMed Scopus (35) Google Scholar , 7 Khanam T Anaesthetic risks in rheumatoid arthritis. Br J Hosp Med. 1994; 52: 320 PubMed Google Scholar and/or systemic vasculitis 6 Skues MA Welchew EA Anaesthesia and rheumatoid arthritis. Anaesthesia. 1993; 48: 989 Crossref PubMed Scopus (35) Google Scholar , 9 Matti MV Sharrock NE Anesthesia on the rheumatoid patient. Rheum Dis Clin North Am. 1998; 24: 19 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar pose additional problems for general anesthesia. The medications prescribed for RA, such as nonsteroidal anti-inflammatory drugs (NSAIDs), long-term corticosteroids, and antirheumatic drugs, may affect platelet function, 9 Matti MV Sharrock NE Anesthesia on the rheumatoid patient. Rheum Dis Clin North Am. 1998; 24: 19 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar irritate gastrointestinal mucosa, 6 Skues MA Welchew EA Anaesthesia and rheumatoid arthritis. Anaesthesia. 1993; 48: 989 Crossref PubMed Scopus (35) Google Scholar confer susceptibility to infectious diseases, 9 Matti MV Sharrock NE Anesthesia on the rheumatoid patient. Rheum Dis Clin North Am. 1998; 24: 19 Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar and/or affect liver and kidney function. 6 Skues MA Welchew EA Anaesthesia and rheumatoid arthritis. Anaesthesia. 1993; 48: 989 Crossref PubMed Scopus (35) Google Scholar , 7 Khanam T Anaesthetic risks in rheumatoid arthritis. Br J Hosp Med. 1994; 52: 320 PubMed Google Scholar