Abstract
Background
Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease which can cause significant disability, morbidity, mortality, and impaired fertility. It commonly affects women of childbearing age. Managing rheumatoid arthritis (RA) in the perinatal period poses challenges. There is concern about the teratogenic effects of many traditional disease-modifying anti-rheumatic drugs (DMARDs) and an ever-growing list of new therapeutic options with limited data in pregnancy and breastfeeding.
Aims
We aimed to create a standardized approach to pharmacological management of RA patients seen in our newly established Rheumatology and Reproductive Health Service.
Methods
We reviewed relevant publications on the use of anti-rheumatic drugs in pregnancy. These include recent guidelines from The British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) and the European League Against Rheumatism (EULAR).
Results
After considering relevant publications, we developed a Saint Vincent’s University Hospital/National Maternity Hospital consensus protocol for evidence-based medication in pregnancy in RA.
Conclusions
RA tends to improve during pregnancy and flare postpartum. Several anti-rheumatic medication options during pregnancy and breastfeeding are now available including anti-tumor necrosis factor (anti-TNF) agents. Good disease control at all stages of reproduction is important to ensure best outcome for both mother and baby.
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References
Wallenius M, Salvesen KA, Daltveit AK, Skomsvoll JF (2014) Rheumatoid arthritis and outcomes in first and subsequent births based on data from a national birth registry. Acta Obstet Gynecol Scand 93(3):302–307
Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldingsnes W, Mikkelsen K, Kaufmann C, Kvien TK (2011 Jun) Pregnancy and delivery in women with chronic inflammatory arthritides with a specific focus on first birth. Arthritis Rheum 63(6):1534–1542
de Man YA, Dolhain RJ, van de Geijn FE et al (2008) Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Rheum 59(9):1241–1248
de Man YA, Hazes JM, van der Heide H et al (2009 Nov) Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum 60(11):3196–3206
Østensen M, Andreoli L, Brucato A, Cetin I, Chambers C, Clowse MEB, Costedoat-Chalumeau N, Cutolo M, Dolhain R, Fenstad MH, Förger F, Wahren-Herlenius M, Ruiz-Irastorza G, Koksvik H, Nelson-Piercy C, Shoenfeld Y, Tincani A, Villiger PM, Wallenius M, von Wolff M (2015) State of the art: reproduction and pregnancy in rheumatic diseases. Autoimmun Rev 14(5):376–386
Østensen M, von Esebeck M, Villiger PM et al Therapy with immunosuppressive drugs and biological agents and use of contraception in patients with rheumatic disease. J Rheumatol 34:1266–1269
Hench PS (1938) The ameliorating effect of pregnancy on chronic atropic infections rheumatoid arthritis, fibrosititis and intermittent hydrarthrosis. InProc Staff Meet Mayo Clin 13:161–175
Krause ML, Amin S, Makol A (2014 Oct) Use of DMARDs and biologics during pregnancy and lactation in rheumatoid arthritis: what the rheumatologist needs to know. Ther Adv Musculoskelet Dis 6(5):169–184
Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I, on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group (2016 Sep) BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding—Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford) 55(9):1693–1697
European Medicines Agency, Leflunomide (Arava) 10mg tablets, European Product Assessment Report updated June 2016
Brouwer J, Hazes J, Dolhain R et al (2015) Fertility of women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 74:1836–1841
Cheent K, Nolan J, Shariq S, Kiho L, Pal A, Arnold J (2010) Case report: fatal case of disseminated BCG infection in an infant born to a mother taking infliximab for Crohn’s disease. Crohns Colitis 4(5):603–605
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The authors declare that they have no conflict of interest.
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This article does not contain any studies with human participants or animals performed by any of the authors.
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Informed consent was not required as this study was a review of the relevant literature and guidelines on the topic.
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Kieran E. Murray and Louise Moore are joint first authors
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Murray, K.E., Moore, L., O’Brien, C. et al. Updated pharmacological management of rheumatoid arthritis for women before, during, and after pregnancy, reflecting recent guidelines. Ir J Med Sci 188, 169–172 (2019). https://doi.org/10.1007/s11845-018-1829-7
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DOI: https://doi.org/10.1007/s11845-018-1829-7