Perioperative care of the patient with a multisystem inflammatory (rheumatic) disease has become increasingly complex and perioperative medicine has evolved into its own subspecialty. Physicians who have expertise in managing patients with rheumatic disease infrequently spend significant time also managing patients undergoing surgical procedures, and the reverse is equally true. Despite the burgeoning literature on the medical management of the surgical patient, scant data have been generated regarding patients with complex rheumatic disease.