摘要：背景：類風濕關節炎(RA)是一種慢性免疫介導的炎症性疾病，可導致嚴重殘疾、並發症、死亡和生育能力受損。該病常發生於育齡期女性。給圍產期類風濕關節炎(RA)的治療帶來了挑戰。許多傳統改善病情抗風濕藥物(DMADS)和越來越多的新的治療藥物在妊娠和哺乳期的數據有限，這些藥物的致畸作用受到關注。目的：本研究的目的是針對在我們新成立的風濕病和生殖健康服務體係就醫的RA患者建立一個標準化的藥物管理方法。方法：我們回顧了有關在妊娠期使用抗風濕藥物的相關文獻。包括來自英國風濕病學會(BSR)和英國風濕病衛生專業人員(BHPR)和歐洲抗風濕病聯盟(EURAR)製定的最新指南。結果：在參考相關出文獻之後，我們開發了聖文森特大學醫院/國家婦產醫院在RA中基於循證醫學的用藥共識。結論：RA患者趨於在懷孕期間病情改善，而產後病情易複發。目前有幾種抗風濕藥物在懷孕和哺乳期可供選擇，包括抗腫瘤壞死因子(抗TNF)藥物。在生育的各個階段良好的疾病控製對於確保母嬰的最佳結局至關重要。
附原文:Abstract BACKGROUND:Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease which can cause significant disability, morbidity, mortality, and impaired fertility. It commonly affects women of childbearing age. Managing rheumatoid arthritis (RA) in the perinatal period poses challenges. There is concern about the teratogenic effects of many traditional disease-modifying anti-rheumatic drugs (DMARDs) and an ever-growing list of new therapeutic options with limited data in pregnancy and breastfeeding.AIMS:We aimed to create a standardized approach to pharmacological management of RApatients seen in our newly established Rheumatology and Reproductive Health Service.METHODS:We reviewed relevant publications on the use of anti-rheumatic drugs in pregnancy. These include recent guidelines from The British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) and the European League Against Rheumatism (EULAR).RESULTS:After considering relevant publications, we developed a Saint Vincent's University Hospital/National Maternity Hospital consensus protocol for evidence-based medication in pregnancy in RA.CONCLUSIONS:RA tends to improve during pregnancy and flare postpartum. Several anti-rheumatic medication options during pregnancy and breastfeeding are now available including anti-tumor necrosis factor (anti-TNF) agents. Good disease control at all stages of reproduction is important to ensure best outcome for both mother and baby.
引自：Murray KE, Moore L, O'Brien C, et al. Updated pharmacological management of rheumatoid arthritis for women before, during, and after pregnancy, reflecting recent guidelines.Ir J Med Sci. 2018 May 10. doi: 10.1007/s11845-018-1829-7. [Epub ahead of print]
