Disease control prior to pregnancy nets better outcomes in patients with rheumatic diseases
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Sufficient disease control prior to conception can reduce the risk for pregnancy complications in patients with rheumatic conditions, according to a press release announcing data published in Rheumatic Disease Clinics of North America.
In a review article published in part by physicians from the University of Texas Southwestern Medical Center, the authors analyzed the potential risks and considerations regarding pregnancy for three prominent rheumatic diseases — rheumatoid arthritis, systemic lupus erythematosus and obstetric antiphospholipid syndrome — and the medications used to treat them.
“Rheumatologic disorders are common amongst women of reproductive age,” Bonnie Bermas, MD, professor of internal medicine at the division of rheumatic diseases at UT Southwestern, said in the release posted by the institution. “Understanding the management of rheumatic diseases in pregnant women is an important part of patient care for rheumatologists. If we have a better understanding of pregnancy management in our patients, then we can help patients achieve their family planning goals.”
In their review, the authors conclude that roughly half of all patients with RA achieve disease remission during pregnancy. Discontinuing medication prior to pregnancy without achieving remission makes patients more likely to experience flares during pregnancy, the release said.
For patients with SLE, continuing hydroxychloroquine throughout pregnancy improves outcomes, according to the researchers. In addition, patients with “very active” disease before conception and active renal disease exhibit poorer outcomes. However, they noted that achieving effective treatment for renal flares during therapy is difficult due to the intrinsic difficulty in differentiating preeclampsia from SLE flares.
Regarding patients with obstetric APS, the authors stated they often require anticoagulation therapy and low-dose aspirin throughout pregnancy.
“Our knowledge regarding the safety of medications during pregnancy is limited because pregnant women are excluded from the majority of clinical trials,” Bermas said in the release.
Medications including hydroxychloroquine, azathioprine, cyclosporine, tacrolimus (Prograf, Astellas Pharma) and low-dose aspirin are deemed safe throughout pregnancy and the lactation period, the authors added.
References:
Castro-Gutierrez A, et al. Rheum Dis Clin N Am.2022;doi:10.1016/j.rdc.2022.02.009.
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