Fertility, pregnancy planning, and pharmacotherapy during the pregnancy, postpartum and breastfeeding period in patients with rheumatoid arthritis and other inflammatory arthropathies
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Submission date: 2013-12-19
Acceptance date: 2014-02-10
Online publication date: 2014-03-23
Publication date: 2014-02-28
Reumatologia 2014;52(1):7–21
The peak in incidence of the majority of inflammatory arthropathies (IAs) is observed in the 2nd–4th decades of life. Thus the diseases affect patients at reproductive age. The results of population studies have demonstrated that these diseases can exert effects on the fertility of the patients, family planning, course of pregnancy and further development of the baby. It has also been shown that female patients with IAs, compared with healthy women, less frequently decide to have the first and other babies and the interval between successive pregnancies is longer. The aim of pharmacotherapy in a patient with IA who plans to become pregnant is to effectively inhibit the inflammatory activity and to maintain remission/low activity of the disease during pregnancy and after its termination. Disease-modifying drugs suitable for administration in the preconception period and pregnancy include: chloroquine, hydroxychloroquine, sulfasalazine, azathioprine, ciclosporin A, glucocorticosteroids and non-steroidal anti-inflammatory drugs. The following should not be administered: out of the synthetic disease-modifying drugs – methotrexate, leflunomide, cyclophosphamide and mycophenolate mofetil; and out of biological drugs – abatacept, tocilizumab and rituximab.
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