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Irish Journal of Medical Science (1971 -)

, Volume 188, Issue 1, pp 169–172 | Cite as

Updated pharmacological management of rheumatoid arthritis for women before, during, and after pregnancy, reflecting recent guidelines

  • Kieran E. MurrayEmail author
  • Louise Moore
  • Celine O’Brien
  • Anne Clohessy
  • Caroline Brophy
  • Patricia Minnock
  • Oliver FitzGerald
  • Eamonn S. Molloy
  • Anne-Barbara Mongey
  • Shane Higgins
  • Mary F. Higgins
  • Fionnuala M. Mc Auliffe
  • Douglas J. Veale
Review Article

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.

Keywords

Arthritis Peripartum Pregnancy Rheumatoid arthritis Teratogen 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was not required as this study was a review of the relevant literature and guidelines on the topic.

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Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  • Kieran E. Murray
    • 1
    • 2
    Email author
  • Louise Moore
    • 1
  • Celine O’Brien
    • 3
  • Anne Clohessy
    • 3
  • Caroline Brophy
    • 3
  • Patricia Minnock
    • 1
  • Oliver FitzGerald
    • 1
    • 2
  • Eamonn S. Molloy
    • 1
    • 2
  • Anne-Barbara Mongey
    • 1
    • 2
  • Shane Higgins
    • 3
  • Mary F. Higgins
    • 3
  • Fionnuala M. Mc Auliffe
    • 3
  • Douglas J. Veale
    • 1
    • 2
  1. 1.Rheumatic Musculoskeletal Disease UnitOur Lady’s Hospice an Dublin d Care ServicesHarold’s CrossIreland
  2. 2.Rheumatology DepartmentUniversity College Dublin and St. Vincent’s University HospitalDublin 4Ireland
  3. 3.UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of MedicineUniversity College Dublin, National Maternity HospitalDublinIreland

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