REVIEW - Pregnancy and rheumatoid arthritis

[Guest guest]

Indian Journal of Medical Sciences

PRACTITIONERS SECTION

Year : 2006 | Volume : 60 | Issue : 8 | Page : 334-344

Pregnancy and rheumatoid arthritis

Tandon Vishal R1, Sharma Sudhaa2, Mahajan Annil3, Khajuria Vijay1, Kumar Ajay1

1 Post Graduate Departments of Pharmacology and Therapeutics, Govt

Medical College, Jammu, India

2 Post Graduate Departments of Obstetrics and Gynecology, Govt Medical

College, Jammu, India

3 Post Graduate Departments of General Medicine, Govt Medical College,

Jammu, India

Abstract

Pregnancy in most cases, is associated with remission of rheumatoid

arthritis (RA), but a quarter of patients continue to have active

disease or even worsening of the disease and most patients who

improve, relapse in the postpartum period. The pathophysiology of this

improvement in disease activity during pregnancy remains unknown, but

hormonal, cell-mediated immunological and humoral immunological

changes during pregnancy, have been proposed responsible for this.

Most of the pregnant women with RA have an uneventful course, with no

significant complications. In general, no significant increase in

maternal or fetal morbidity seems to be attributable to RA. Patients

with RA do not have decreased fertility. A majority of patients with

RA may go in remission and anti-rheumatic treatment may not be

required as soon as women become pregnant. But other patients who

continue with the disease activity require treatment. The preferred

disease-modifying agents during pregnancy are sulfasalazine and

hydroxychloroquine. Azathioprine and cyclosporine can be used if the

benefits outweigh the risks. Paracetamol and low dose prednisone are

preferred and considered safe, both for mother and fetus. Methotrexate

and lefunomide are contraindicated and must be prophylactically

withdrawn before a planned pregnancy. Biologics generally should be

stopped when pregnancy is discovered. An overall rational approach is

highly warranted to treat RA during pregnancy.

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Read the entire article here:

http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2006;volume=60;issu\

e=8;spage=334;epage=344;aulast=Tandon

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Not an MD