medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 11

Ginecol Obstet Mex 2020; 88 (11)

Rheumatoid arthritis and pregnancy. A case report and literature review

Piñel-Pérez CS, Gómez-Roso JMJ, Caliendo CG, Steinberg-Contreras GH, López-Galián JJ

Language: Spanish
References: 29
Page: 806-814
PDF size: 344.37 Kb.


ABSTRACT

Background: The course of rheumatoid arthritis generally improves during pregnancy, but there are a significant number of patients who maintain active disease. In these cases, an increased risk of complications (first trimester abortions, prematurity, pre-eclampsia and restricted intrauterine growth) has been reported, as well as a higher probability of cesarean section.
Case Report: 40-year-old patient, in the first pregnancy, with a previous diagnosis of rheumatoid arthritis in remission who managed to obtain her pregnancy after nine embryo transfers, maintaining treatment with glucocorticoids, hydroxychloroquine, and adalimumab. Pregnancy went without obstetric complications or outbreaks of rheumatoid arthritis. Treatment with hydroxychloroquine and adalimumab was withdrawn at week 20. Cesarean section was performed at week 39 due to failure of induction. A healthy newborn of 3095 grams was obtained, who did not require neonatal resuscitation or admission to the neonatal intensive care unit. Obtained an umbilical artery pH of 7.27 and Apgar 9/10. The puerperium passed without medical or obstetric complications.
Conclusion: The planning of pregnancy is essential in women with rheumatoid arthritis, and should start in the period of remission of the disease. Obstetric compli- cations are associated with pregnancies initiated in the active phase of rheumatoid arthritis. Treatment with low-dose glucocorticoids during the first phase of pregnancy (hydroxychloroquine, and anti-TNF biologic drugs) have shown maternal-fetal safety and efficacy in keeping the disease in remission.


REFERENCES

  1. Lee DM, et al. Rheumatoid arthritis. Lancet 2001; 358 (9285): 903-11. doi: https://doi.org/10.1016/S0140- 6736(01)06075-5

  2. Turrión-Nieves A, et al. Artritis reumatoide. Medicine 2017; 12 (28): 1615-25. doi: https://doi.org/10.1016/j. med.2017.02.010

  3. Crowson CS, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum 2011; 63 (3): 633-9. doi: https://doi.org/10.1002/art.30155

  4. Smolen JS, et al. Rheumatoid arthritis. Lancet 2016; 388 (10055): 2023-38. doi: https://doi.org/10.1016/S0140- 6736(16)30173-8

  5. Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs; 2013 update. Ann Rheum Dis 2014; 73 (3): 492-509. doi: https://doi. org/10.1136/annrheumdis-2013-204573

  6. Smeele HTW, et al. Current perspectives on fertility, pregnancy and childbirth in patients with Rheumatoid Arthritis. Semin Arthritis Rheum 2019; 49 (3S): S32-S35. doi: https:// doi.org/10.1016/j.semarthrit.2019.09.010

  7. Fischer-Betz R, et al. Schwangerschaft bei rheumatischen erkrankungen. Z Rheumatol 2020; 79 (1): 55-73. doi: https://doi.org/10.1007/s00393-013-1223-9

  8. Maynard S, et al. Pregnancy in women with systemic lupus and lupus nephritis. Adv Chronic Kidney Dis 2019; 26 (5): 330-7. doi: https://doi.org/10.1053/j.ackd.2019.08.013

  9. Piñel-Pérez CS, et al. Poliarteritis con daño pulmonar (Churg-Strauss) y embarazo. Reporte de un caso y revisión bibliográfica. Ginecol Obstet Mex 2019; 87 (11): 756-61. doi: https://doi.org/10.24245/gom.v87i11.3329

  10. Brouwer J, et al. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis 2015; 74 (10): 1836-41. doi: https://doi. org/10.1136/annrheumdis-2014-205383

  11. Norgaard BM, et al. Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study. Ann Rheum Dis 2019; 78 (3): 328-34. doi: https://doi.org/10.1136/ annrheumdis-2018-214619

  12. Förger F, et al. Immunological adaptations in pregnancy that modulate rheumatoid arthritis disease activity. Nat Rev Rheumatol 2020; 16 (2): 113-22. doi: https://doi. org/10.1038/s41584-019-0351-2

  13. Jethwa H, et al. Does rheumatoid arthritis really improve during pregnancy? A systematic review and meta-analysis. J Rheumatol 2019; 46 (3): 245-50. doi: https://doi. org/10.3899/jrheum.180226

  14. Norgaard M, et al. Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Intern Med 2010; 268 (4): 329-37. doi: https://doi. org/10.1111/j.1365-2796.2010.02239.x

  15. De Jong P, et al. Fertility, pregnancy and lactation in rheumatoid arthritis. Rheum Dis Clin North Am 2017; 43 (2): 227-37. doi: 10.1016/j.rdc.2016.12.004 (https://www. rheumatic.theclinics.com/article/S0889-857X(16)30107-7/ fulltext)

  16. Kishore S, et al. Obstetric outcomes in women with rheumatoid arthritis: results from nationwide inpatient sample database 2003-2011. Semin Arthritis Rheum 2019; 49 (2): 236-40. doi: https://doi.org/10.1016/j.semarthrit. 2019.03.011

  17. Ince-Askan H, et al. Pregnancy and rheumatoid arthritis. Best Pract Res Clin Rheumatol 2015; 29 (4-5): 580-96. doi: https://doi.org/10.1016/j.berh.2015.07.001

  18. Brouwer J, et al. Brief Report: Miscarriages in female rheumatoid arthritis patients: associations with serologic findings, disease activity and antirheumatic drug treatment. Arthritis Rheumatol 2015; 67 (7): 1738-43. doi: https://doi. org/10.1002/art.39137

  19. Bermas BL. Non-steroidal anti inflammatory drugs, glucocorticoids and disease modifying anti-rheumatic drugs for the management of rheumatoid arthritis before and during pregnancy. Curr Opin Rheumatol 2014; 26 (3): 334-40. doi: https://doi.org/10.1097/BOR.0000000000000054

  20. Birru Talabi M, et al. Antirheumatic medications in pregnancy and breastfeeding. Curr Opin Rheumatol 2020; 32 (3): 238-46. doi: https://doi.org/10.1097/ BOR.0000000000000710

  21. Alijotas-Reig J, et al. Tratamiento de las gestantes con enfermedades reumáticas o autoinmunitarias sistémicas con fármacos inmunodepresores y biológicos. Med Clin 2016; 147 (8): 352-60. doi: https://doi.org/10.1016/j. medcli.2016.05.020

  22. Nguyen GC, Jones J et al. IBD in pregnancy consensus group; Canadian Association of Gastroenterology. The Toronto Consensus statements for the management of inflammatory bowel disease in pregnancy. Gastroenterol 2016; 150 (3): 734-57. doi: https://doi.org/10.1053/j. gastro.2015.12.003

  23. Chaudrey KH, et al. Safety of immunomodulators and anti- TNF therapy in Pregnancy. Curr Trat Options Gastroenterol 2015; 13 (1): 77-89. doi: https://doi.org/10.1007/s11938- 014-0037-4

  24. Mahadevan U, et al. Placental transfer of anti-tumor necrosis factor agents in pregnant patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2013; 11 (3): 286-92; quiz e24. doi: https://doi.org/10.1016/j. cgh.2012.11.011

  25. Chaparro M, et al. Long-term safety of in utero exposure to anti-TNFalfa drugs for the treatment of infmammatory bowel disease: results from the multicenter European TEDDY Study. Am J Gastroenterol 2018; 113 (3): 396-403. doi: https://doi.org/10.1038/ajg.2017.501

  26. Gotestam Skorpen C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, during pregnancy and lactation. Ann Rheum Dis 2016; 75 (5): 795-810. doi: https://doi.org/10.1136/annrheumdis-2015-208840

  27. Iranzo González-Cruz I, Gil Borrás R, Martín Arranz MD, García Corbalán MJ, Jaén Revuelta M. Uso de adalimumab durante la gestación en la enfermedad de Crohn. Enferm Inflam Intest Día. 2017; 16 (3): 158-62. doi: https://doi. org/10.1016/j.eii.2016.12.005

  28. Chambers CD, et al. Birth outcomes in women who have taken adalimumab in pregnancy: A prospective cohort study. PLoS One 2019; 14 (10): e0223603. doi: https://doi. org/10.1371/journal.pone.0223603

  29. APILAM. Asociación para la promoción e investigación científica y cultural de la lactancia materna; 2002. http://elactancia. org




2020     |     www.medigraphic.com