INFO - HSS on medications for RA during pregnancy

[Guest guest]

Hospital for Special Surgery

" Pregnancy in Autoimmune and Musculoskeletal Disease " :

A. Paget, MD: Are there any medications a patient with rheumatoid

arthritis can take during the pregnancy?

Sammaritano, MD: Sure there are, and when talking about medicine and

pregnancy, I guess overall the idea is looking at it as a spectrum. There

are medications that have been around for a long time, such as

corticosteroids, where we observed patients for many, many years and feel

that low to moderate doses, especially, are fine during pregnancy. They have

their own set of side effects in terms of internal problems, but in terms of

fetal development and fetal problems, they tend not to affect the fetus. So,

when possible, we rely on low-dose steroids during pregnancy for women with

rheumatoid arthritis, unlike pre-pregnancy or postpregnancy.

There are other medications. The common medication used for rheumatoid

arthritis, methotrexate, merits special attention, because that is actually

contraindicated totally during pregnancy. It causes craniofacial and limb

deformity in developing fetuses, and so that needs to be stopped three

months before one becomes pregnant. It is important for patients to realize

that ahead of time, and it is actually something that I address with

patients when I start them on a remittive drug. You know, since a lot of

these woman are young, of child-bearing age, it is important to address this

even when making a decision about what medication might be best to start

with.

A. Paget, MD: So, in general, in most patients with rheumatoid

arthritis you try to stop all of the medications except the steroids?

Sammaritano, MD: I do. Anti-inflammatories are not as well studied

during pregnancy as is aspirin, which has been around for a long time. They

are probably okay to take during pregnancy up until the last couple of

months; at that point you need to worry about affects on the fetus in terms

of ductus arteriosis and premature closure that can cause pulmonary

hypertension in the fetus. And they can also prolong labor. Before that, a

lot of patients will take anti-inflammatories if needed; probably ibuprofen

is considered the safest one. Personally, I have found that for the degree

of response, 5 mg of prednisone tends to give a better response in many

patients, probably with less potential for side effects.

A. Paget, MD: What about some of our newer medications, the anti-TNF

medications such as etanercept and inflixamab? Is there is enough

information to demonstrate safety or lack of?

Sammaritano, MD: No, there is not enough information to demonstrate

either of those. I think that, in general, one would hope that just by

virtue of remission occurring that it would be possible to discontinue that

medication. It is difficult to note, because it is so new. And it's not that

a controlled study will ever be done on these medications during pregnancy.

I think the FDA has actually classified Enbrel as Category B in pregnancy,

which means actually that there is no data that says it's a bad thing, no

data in animals, for example, that show a lot of deformity or other

problems. I try to stop it. If the patient has very severe disease, though,

I think you have to weigh the potential risks versus the benefit and make

that decision.

http://www.hss.edu/Professionals/Conditions/Autoimmune-Diseases/Autoimmune-Pregn\

ancy

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org