Rheumatoid Arthritis in Pregnancy

Abstract

Rheumatoid arthritis is an autoimmune erosive polyarthropathy that can affect young women of childbearing age. In more than 50% of the women, RA improves by the end of the first trimester, and the disease activity is less severe during pregnancy. Moderate-to-severe disease activity during pregnancy could be controlled with the use of conventional or biological DMARDs and corticosteroids. The maternal and fetal outcomes are generally good in women with well-controlled disease; however in women with active disease, there is a higher risk of preterm delivery and small for gestational age infants. Anesthesiologists need to be aware of the disease manifestations and the drugs used in the management of RA in order to avoid complications during labor and delivery. RA can cause arthritis of the cervical spine, temporomandibular, and cricoarytenoid joints which can lead to difficult endotracheal intubation. The extra-articular involvement of the heart and the lungs can further complicate the anesthetic management. Some of the medications used to manage RA can increase the risk of infections. Neuraxial anesthesia can be safely performed for labor and delivery and general anesthesia is best avoided when possible.