As elderly population is growing rapidly, the number of patients with arthritis is also increasing. Because of the prolonged lifetime, arthritic patients become to have more chances to undergo surgical procedures. Many of these patients chronically receive medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid, and various disease-modifying anti-rheumatic disease (DMARDs) including biologic agents. Decisions regarding withholding or modifying the regimens of these medications may be critical in the perioperative period to optimize surgical outcome. Consultation with a rheumatologist is recommended, but the surgeon also should be aware of these medications. This review article suggests a balanced perioperative medication management to minimize potential surgical complications and maintain disease control in arthritic patients.