Changes in Rheumatoid Arthritis Pharmacotherapy During Pregnancy

Clinicians should consider supplementation with calcium 1.25 g/day and vitamin D or a combined formula for bone protection for all pregnant women taking steroids.1 A 2011 study by Dr Kuriya and associates found that glucocorticoids, received by >30% of women, comprised the largest number of RA therapies dispensed during the gestational period, and that they were used more frequently during pregnancy than before.15

“Since many DMARDs are contraindicated during pregnancy, and we have seen that some NSAIDs may be harmful, steroids at low to moderate doses are often preferred to treat flares of RA during pregnancy,” Dr Kuriya stated.

More research is needed on the effect of RA on disease activity and the effects of RA medications on the fetus, especially as the RA treatment armamentarium expands. The benefits of maintaining good disease control and avoiding progression must be balanced with potential medication risks.  

“I believe rheumatologists are increasingly becoming better at counseling women about the risks and benefits of RA therapies but also of the impact of the disease itself.  Tools such as national guidelines about the safety of drugs during pregnancy and lactation help physicians in their counseling, but greater education and outreach are still needed to keep up with all of the emerging new therapies we have for RA,” noted Dr Kuriya.


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