For reading and reference only
Patients with rheumatoid arthritis should pay attention to fetal health when taking drugs during pregnancy.
Rheumatoid arthritis (RA) is a common systemic autoimmune disease characterized by chronic inflammatory lesions of the joints, with several times more common incidence in women than in men [1]. Current research suggests that although RA does not affect fetal health, some rheumatoid arthritis treatment drugs can have an impact on fetal health [1].
After Kobayashi's rheumatoid arthritis stabilized, he was always looking forward to having a baby. After 10 months of pregnancy, the good news finally came!
Due to the decline in the ability of rheumatoid arthritis (RA) women to conceive, compared with normal women to extend the time of conception, the baby is not easy to come by, so after pregnancy will be more careful, afraid that the drugs taken will have adverse effects on the fetus.
So, in order to avoid the effect of the drug on the fetus, can the drug be discontinued during pregnancy?
PART 1
For yourself, for children
Medication is adhered to during pregnancy
Rheumatoid arthritis is a chronic disease, and the core treatment strategy is to achieve remission and reduce disease activity [2].
Patients with RA need to be controlled and stabilized during both pregnancy and pregnancy, and the condition is effectively controlled during pregnancy, and there is no significant difference between pregnancy outcomes and healthy people [3].
However, during pregnancy, changes in the mother's immune status may lead to an increase in disease activity. Up to 46.7 percent of patients with RA have been shown to relapse in the postpartum period [4]. If the patient is worried about the impact of the drug on the fetus, choosing to stop drug treatment at this time may not only increase the risk of recurrence of the disease, but also may affect the health of the fetus.
Multiple studies have found that the severity of rheumatoid arthritis in women is associated with the risk of adverse pregnancy outcomes, with high disease activity significantly increasing the risk of fetal preterm birth and low birth weight, the risk of caesarean section in patients with relatively low disease activity in patients with high disease activity, but also an increased [5,6], and high disease activity also increases the risk of hypertensive disease during maternal pregnancy [7].
Effect of rheumatoid arthritis disease severity on adverse pregnancy outcomes in women[5]
Therefore, RA patients should still actively control disease activity during pregnancy to ensure a smooth delivery of a healthy baby and prevent recurrence of their own disease.
Authoritative international and national guidelines also clearly state that women with RA are available during pregnancy.
PART 2
Medication is given during pregnancy in patients with RA
Both the mother and the fetus can be taken into account
Medication for patients with RA during pregnancy, compared with the preparation for pregnancy, needs to effectively control the mother's condition at the same time, it is indeed necessary to pay more attention to the impact of the drug on the fetus, to avoid fetal malformations, premature birth and other results.
Therefore, the medication regimen for the preparation of pregnancy needs to be adjusted. (The patient's medication during pregnancy preparation, for details, can be seen: "Preparing for pregnancy, which rheumatoid arthritis drugs must be stopped, and which can be continued?") 》）
Table 1: Recommendations for women with rheumatoid arthritis during pregnancy[8]
PART 3
Safe medication in ra patients during pregnancy,
These can continue to be used
1. The use of drugs is continued during pregnancy
Tumor necrosis factor (TNF)-α inhibitor
It is relatively safe to use TNF-α inhibitors during pregnancy in patients with RA, and the preferred TNF-α inhibitor is pesselizumab. Peselizumab is an innovative inhibitor of TNF-α with a unique Fc-free structure that is rarely transported through the placenta. It is particularly convenient that the drug can be used throughout pregnancy, pregnancy and lactation, without the need to adjust the dose, safe and effective.
Other TNF-α inhibitors contain Fc segments that bind to neonatal Fc receptors (FcRn) and have higher placental transport rates (especially in the third trimester). Therefore, TNF-α inhibitors containing the Fc segment should be discontinued in the third trimester of pregnancy to reduce the potential risk to the fetus caused by the drug entering the fetal circulation, and the specific discontinuation time varies depending on the half-life of the drug [8-9].
Other drugs
There are also other safe drugs that can be used during pregnancy, such as hydroxychloroquine, sulfasalazine, colchicine, etc.
2. The drug that continues to be used during pregnancy is not recommended
Biologics
Since the safety of some biologics during pregnancy is unknown, they should be used with caution, such as scuciyuzumab, belijumab, anaplakin, etc.
Drugs that are at risk of teratogenicity, such as methotrexate and leflunomide, need to be discontinued some time before pregnancy [9].
October Pregnancy Recommendations:
Women with rheumatoid arthritis are pregnant with effective disease control, pregnancy outcomes are not significantly different from healthy women, and during pregnancy, there are drugs available to effectively control the disease while avoiding fetal effects.
Female patients with rheumatoid arthritis should plan their pregnancy under the supervision of a doctor, review it regularly, adjust the medication plan in time at all stages of pregnancy preparation and pregnancy, and believe that they can have a healthy baby as desired.
bibliography:
[1].Rheumatology Branch of Chinese Medical Association.2018 Chinese Rheumatoid Arthritis Diagnosis and Treatment Guidelines.Chinese Journal of Internal Medicine, 2018,57(4): 242-251
Niu Hongqing, Zhang Liyun, Li Xiaofeng, et al. Research progress on efficacy evaluation index of rheumatoid arthritis[J].Chinese Journal of Rheumatology.2008.12:55-57.
[3]. Ideal Clinical Pathway Improves Pregnancy Outcomes in RA - Medscape - Jan 17, 2020.
[4]. Jethwa H, et al. Does Rheumatoid arthritis Really Improve During Pregnancy? A Systematic Review and Meta-analysis. J Rheumatol. 2019 Mar;46(3):245-250.
[5]. Bharti B, Lee SJ, Lindsay SP, Wingard DL, Jones KL et al. Disease severity and pregnancy outcomes in women with rheumatoid arthritis: results from the organisation of teratology. J Rheumatol. 2015;42(8):1376–1382.
[6]. Branch DW. Pregnancy in patients with rheumatic diseases: obstetric management and monitoring. Lupus. 2004. 13(9):696-8.
[7]. Gaillard AL, Barnetche T, Schaeverbeke T. Pregnancy Outcomes in Women with Rheumatoid Arthritis : A Systematic Review and Meta-Analyses. Arthritis Rheumatol. 2016;68(suppl 10). ACR abstract 1533.
[8]. Xu C . 2020 American College of Rheumatology guideline for the management of gout: switch or not switch febuxostat[J]. Arthritis & Rheumatology.
Zhang Wen, Li Yisha, Liu Dongzhou, et al. Specifications for the use of drugs in the perinatal period of rheumatic diseases[J].Chinese Journal of Internal Medicine,2021,60(11):946-953.
* This article is for the purpose of providing scientific information only and does not represent the position of the Platform