What are your recommendations for perioperative management of DMARDs and biologics in patients undergoing bariatric surgery?

One of the goals of the ACR's perioperative guidelines (Goodman et al., PMID 35718887) was to avoid unnecessarily long interruptions in therapy in the perioperative setting, which increases the risk of disease flares, can lead to increased glucocorticoid use in the perioperative setting (which is associated with adverse perioperative outcomes and poor wound healing), may impact rehabilitation, and affects quality of life.

The ACR Guidelines focused on hip and knee arthroplasty - major procedures that include prosthetic material (with the associated risks for prosthetic joint infection). I believe that extrapolating these guidelines to other major surgical procedures is very reasonable - continuing methotrexate, hydroxychloroquine, leflunomid...