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妊娠对类风湿关节炎的积极影响,以及妊娠期间类风湿关节炎的药物治疗管理。

The positive effect of pregnancy in rheumatoid arthritis and the use of medications for the management of rheumatoid arthritis during pregnancy.

机构信息

Acharya and BM Reddy College of Pharmacy, Soldevanahalli, Bangalore, Karnataka, India.

出版信息

Inflammopharmacology. 2021 Aug;29(4):987-1000. doi: 10.1007/s10787-021-00808-9. Epub 2021 Apr 12.

Abstract

Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disorder that is mostly characterised by progressive symmetrical joint destruction, particularly in the wrist and fingers, while it may also affect additional joints and several organs, such as the skin, heart, blood vessels, and lungs. It is identified by raised anti-rheumatoid factor and anti-cyclic citrullinated peptide antibodies. The chemical mediators involved in the activity of RA are IL-1β, TNF-α, and IL-6. Pregnancy exerts a positive effect on RA that helps to modulate the disease condition. Different hypotheses are recommended to explain the ameliorating effect of pregnancy in RA. RA cannot be completely cured. The treatment goal is the attrition of pain and inflammation and the further progression of the disease. Long-term management of RA is carried out using disease-modifying antirheumatic drugs (DMARDs). Therapy of acute flares can be done with Non-steroidal anti-inflammatory drugs (NSAIDs) accompanied by ad interim usage of glucocorticoids. Biologic response modifiers are also available; they act by abolishing the activity of T- cells. However, it is necessary to select the correct treatment regimen when it comes to the management of RA in pregnancy.

摘要

类风湿关节炎(RA)是一种自身免疫性系统性炎症性疾病,主要表现为进行性对称性关节破坏,特别是在手腕和手指,但也可能影响其他关节和多个器官,如皮肤、心脏、血管和肺部。它的特征是类风湿因子和抗环瓜氨酸肽抗体升高。参与 RA 活动的化学介质是 IL-1β、TNF-α 和 IL-6。妊娠对 RA 有积极影响,有助于调节疾病状况。有不同的假说来解释妊娠对 RA 的改善作用。RA 无法完全治愈。治疗目标是减轻疼痛和炎症,进一步控制疾病进展。RA 的长期管理采用改善病情的抗风湿药物(DMARDs)。急性发作的治疗可以使用非甾体抗炎药(NSAIDs),同时临时使用糖皮质激素。也有生物反应调节剂;它们通过抑制 T 细胞的活性起作用。然而,在妊娠期间管理 RA 时,需要选择正确的治疗方案。

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