Medication can also protect women with rheumatoid arthritis from a disease flare-up during pregnancy. This is shown by the results of a study from the Netherlands. However, some women may need to switch medications to avoid endangering the health of the expectant child. The German Society for Rheumatology (DGRh) therefore advises rheumatism patients who wish to have children to consult a specialist at an early stage.
Rheumatic diseases can occur at a young age. This also applies to rheumatoid arthritis, which sometimes begins in adolescence. Since the disease does not heal and only permanent therapy can prevent permanent damage to the joints, women who wish to have children are faced with a dilemma: Do the drugs have to be discontinued and can this trigger a disease relapse?
“Today, we advise patients to continue treatment,” says DGRh President Professor Andreas Krause, MD, chief physician at Immanuel Hospital in Berlin, citing two reasons. On the one hand, treatment increases the chance that pregnancy will occur at all. “Experience shows that high disease activity can lower fertility,” explains Professor Krause: “And in the case of pregnancy, the risk increases that the child will be too small at birth.” In addition, if left untreated, the disease can progress through the nine months of pregnancy and subsequent breastfeeding, causing damage that is irreversible.
However, not all rheumatoid arthritis medications are safe for the baby during pregnancy. “The commonly used methotrexate should be discontinued one to three months before pregnancy,” says Professor Christof Specker, chief physician of rheumatology at the Evangelisches Klinikum Essen-Werden and deputy spokesman of the DGRh’s “Pregnancy” working group. “Cyclophosphamide also should not be used because of the risk of fetal damage. Other agents such as leflunomide are discontinued as a precaution because we don’t know if the child could be harmed.”
Concerns have subsided about the increasingly common drugs in the TNF blocker group. A group of experts from the European League against Rheumatism (EULAR) already spoke out in 2016 in favor of continuing treatment during pregnancy. The TNF blocker certolizumab has now been approved by the European Medicines Agency for use in pregnancy.
A study from the Netherlands now shows that treatment during pregnancy can control disease activity well. A team led by Hieronymus Smeele of Erasmus University in Rotterdam followed 308 women during pregnancy, 184 of whom were taking medication. “Treatment was not easy, as some pregnant women had to switch medications,” explains Professor Krause: “Switching medications is always difficult in rheumatoid arthritis patients, as relapses can occur in between.”
However, this was mostly avoided in the study. “The proportion of women who achieved low disease activity actually increased from 75.4 to 90.4 percent during pregnancy,” Professor Krause reports. These were very good results, she said, since in an earlier study fewer than half of rheumatoid arthritis patients got through pregnancy without any problems. The children were also born healthy. For the expert, the results show that women with rheumatoid arthritis can fulfill their desire to have children without having to fear disadvantages for the health of mother and child. Professor Krause emphasizes, “Because treatment is complex, every rheumatoid arthritis patient should consult a specialist early and, if possible, develop a roadmap together before pregnancy.”
Literature:
- Hieronymus Tw Smeele, et al: Modern treatment approach results in low disease activity in 90% of pregnant rheumatoid arthritis patients: the PreCARA study. Annals of the Rheumatic Diseas- es 2021; 80: 859-864;
https://ard.bmj.com/content/80/7/859.long
- Carina Götestam Skorpen, et al: The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Annals of the Rheumatic Diseases 2016; 75: 795-810;
https://ard.bmj.com/content/75/5/795
Further information: https://dgrh.de/Start/DGRh/Presse/Pressemitteilungen/Pressemitteilungen/2022/Pressemitteilung-Nr.-3-2022.html
