Re: Rhaumatoid arthritis
conym5 - 06-23-09 09:30

Methotrexate and Hydroxychloroquine are contraindicated
Predinisone can be safely used during pregnency

Re: Rhaumatoid arthritis
zkadhem - 06-23-09 11:28

There was a very nice, yet long, CME on this subject on medscape.

Treating RA Flares During Pregnancy

Acute arthritis occurs in about 10-25% of women with RA at some stage of pregnancy.[2-3] For the patient who has active arthritis in one or a few joints, intra-articular steroid injections may give rapid and lasting relief. A short course of high-dose prednisone (for example, >20 mg daily) with gradual reduction over 2-3 weeks may be equally effective. Other options are analgesics such as paracetamol, NSAIDs (until gestational week 32) or low-dose oral corticosteroids over a prolonged period.

Conclusions

The stage and severity of RA must be considered when designing drug therapy for the patient who desires children or who is already pregnant. If possible, remission of RA or stable disease should be achieved before attempting to conceive. Discontinuation of effective therapy when planning a pregnancy could leave the patient without disease suppression for an unknown period of time. If prophylactic withdrawal of possibly fetotoxic drugs is necessary before pregnancy, other therapeutic options must be considered. Immunosuppressive drugs compatible with pregnancy should be chosen in order to avoid a flare of RA during pregnancy or the postpartum period.

Re: Rhaumatoid arthritis
zkadhem - 06-23-09 11:35

Drugs Incompatible With Pregnancy

Methotrexate: Methotrexate exposure in the first trimester increases the risk for congenital abnormalities of the central nervous system, cranial ossification, the limbs and the palate, and can cause growth retardation in animals and humans.
Recommendatio: Methotrexate is contraindicated in pregnancy and should be discontinued 3 months before conception because of its prolonged retention in the tissues. Women should wait at least one menstrual cycle after discontinuation of methotrexate before attempting to become pregnant. After stopping methotrexate, folic acid supplementation should be continued in the preconception and post-conception periods.

Leflunomide: has been assigned an FDA pregnancy category X (a proven teratogen).
Recommendation. Owing to a lack of evidence (85 leflunomideexposed pregnancies have been studied), whether leflunomide is safe in human pregnancy is still uncertain. Therefore, the conservative approach is to exclude pregnancy before leflunomide treatment and to inform patients to practice reliable contraception during therapy. Owing to the long half-life of the active metabolite of leflunomide, the manufacturer advises stopping leflunomide 2 years before a planned pregnancy or use of a washout procedure.[18] Washout with cholestyramine rapidly lowers the blood level of the active leflunomide metabolite when a pregnancy is planned or in case of incidental pregnancy during therapy.

Abatacept: and rituximab are, at present, not considered first-line therapy for RA, but are reserved for patients who fail to respond to treatment with classical DMARDs and tumor necrosis factor (TNF) inhibitors.
Recommendation. No data of abatacept use in human pregnancy experience has been published; therefore, discontinuation at least 10 weeks before a planned pregnancy is recommended.

Rituximab:a monoclonal, B-cell-depleting antibody of the IgG1 subclass, crosses the placenta and, at term, achieves fetal serum levels similar to maternal levels.

Recommendation: Whether preconception or first trimester exposure to rituximab exposes the fetus to any risk is unclear. By contrast, second-trimester and third-trimester exposure causes RA depletion in the fetus, with unknown long-term effects in the child. The manufacturer recommends discontinuation of rituximab 1 year before a planned pregnancy.

Re: Rhaumatoid arthritis
mtniharika - 11-30-09 05:12

The treatment for rheumatoid arthritis during pregnancy needs supervision from both the rheumatologist and the obstetrical provider. This is because some medications used in the treatment are not safe and advisable during pregnancy. Constant meetings with the specialists are needed when undergoing the treatment in which the blood pressure is always measured and the urine is tested. After 10 to 12 weeks of pregnancy, the heart rate of the fetus will be measured too at every visit.

Re: Rhaumatoid arthritis
babbu5508 - 02-23-11 02:19



nice