Fast Five Quiz: Rheumatoid Arthritis Management

Herbert S. Diamond, MD


June 10, 2020

Low-risk treatment options for pregnant patients with RA include SSZ, immunomodulating drugs, and low-dose corticosteroids, as well as antimalarial agents and azathioprine.

Due to teratogenic effects and increased risk of miscarriage, csDMARDs, LEF, and MTX are contraindicated during pregnancy. Moreover, LEF and MTX should be discontinued at least 3 months before a female patient attempts to conceive, and drug level measurements should be performed.

Data on TNF inhibitors and pregnancy are inconclusive, resulting in varying recommendations that range from discontinuing TNF inhibitors upon discovery of conception to discontinuing these drugs in the second trimester to avoid placental transfer. A 2016 study by Bröms and colleagues that collected and reviewed data on 1,272,424 live-born infants in Denmark and Sweden found a slighter higher—albeit not statistically significantly higher—rate of birth defects in infants of patients who were receiving TNF inhibitors during pregnancy.

Learn more about managing RA in pregnant patients.


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