Østensen Monika, Förger Frauke
Department of Rheumatology, Clinical Immunology and Allergology, University Hospital Bern, Bern, Switzerland.
Nat Rev Rheumatol. 2009 Jul;5(7):382-90. doi: 10.1038/nrrheum.2009.103. Epub 2009 Jun 9.
A desire for children or the presence of pregnancy limits the drug therapy options for a woman with rheumatoid arthritis. Combination therapies that include methotrexate or new drugs that have not been studied or used in pregnant patients must be excluded, even though they might be highly efficacious. With few exceptions, the reason for this exclusion is not the proven teratogenicity of the drugs, but the absence of proven safety for the fetus. Whereas methotrexate, leflunomide, abatacept and rituximab must be withdrawn before a planned pregnancy, tumor necrosis factor inhibitors and bisphosphonates can be continued until conception. Antimalarial agents, sulfasalazine, azathioprine and ciclosporin are compatible with pregnancy, and so can be administered until birth. Corticosteroids and analgesics such as paracetamol (acetaminophen) can also be used throughout pregnancy. NSAIDs can be safely administered until gestational week 32. The most important consideration when managing rheumatoid arthritis medications during pregnancy is that therapy must be tailored for the individual patient according to disease activity.
想要孩子或已怀孕会限制类风湿关节炎女性的药物治疗选择。必须排除包含甲氨蝶呤的联合疗法或尚未在孕妇中进行研究或使用的新药，尽管它们可能疗效显著。除少数例外情况外，排除这些药物的原因并非其已被证实具有致畸性，而是缺乏对胎儿的安全性证明。甲氨蝶呤、来氟米特、阿巴西普和利妥昔单抗必须在计划怀孕前停用，而肿瘤坏死因子抑制剂和双膦酸盐类药物可以持续使用至受孕。抗疟药、柳氮磺胺吡啶、硫唑嘌呤和环孢素与妊娠相容，因此可以一直使用至分娩。皮质类固醇和对乙酰氨基酚等镇痛药在整个孕期也可使用。非甾体抗炎药在妊娠32周前可安全使用。孕期管理类风湿关节炎药物时最重要的考虑因素是，必须根据疾病活动情况为个体患者量身定制治疗方案。
