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类风湿关节炎女性患者在孕前、孕期及产后的药物管理更新,反映最新指南。

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

作者信息

Murray Kieran E, Moore Louise, O'Brien Celine, Clohessy Anne, Brophy Caroline, Minnock Patricia, FitzGerald Oliver, Molloy Eamonn S, Mongey Anne-Barbara, Higgins Shane, Higgins Mary F, Mc Auliffe Fionnuala M, Veale Douglas J

机构信息

Rheumatic Musculoskeletal Disease Unit, Our Lady's Hospice an Dublin d Care Services, Harold's Cross, Ireland.

Rheumatology Department, University College Dublin and St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.

出版信息

Ir J Med Sci. 2019 Feb;188(1):169-172. doi: 10.1007/s11845-018-1829-7. Epub 2018 May 10.

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.

摘要

背景

类风湿关节炎(RA)是一种慢性免疫介导的炎症性疾病,可导致严重的残疾、发病、死亡及生育能力受损。它通常影响育龄女性。在围产期管理类风湿关节炎(RA)具有挑战性。人们担心许多传统的改善病情抗风湿药物(DMARDs)的致畸作用,以及越来越多在妊娠和哺乳期数据有限的新治疗选择。

目的

我们旨在为在我们新成立的风湿病与生殖健康服务中心就诊的类风湿关节炎患者创建一种标准化的药物管理方法。

方法

我们回顾了关于抗风湿药物在妊娠中应用的相关出版物。这些包括英国风湿病学会(BSR)和英国风湿病健康专业人员(BHPR)以及欧洲抗风湿病联盟(EULAR)的最新指南。

结果

在考虑相关出版物后,我们制定了圣文森特大学医院/国家妇产医院关于类风湿关节炎妊娠期间循证用药的共识方案。

结论

类风湿关节炎在孕期往往会改善,产后会复发。现在有几种妊娠和哺乳期可用的抗风湿药物选择,包括抗肿瘤坏死因子(抗TNF)药物。在生殖的各个阶段实现良好的疾病控制对于确保母婴获得最佳结局很重要。

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