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Original Article
Available online 25 June 2024
Development of a care protocol in pregnancy and chronic inflammatory arthritis, in a multidisciplinary work group
Elaboración de un protocolo asistencial en el embarazo y las artritis inflamatorias crónicas, en un grupo de trabajo multidisciplinar
Andrea Plumaa, Laia Alsinab,c,d, Estefanía Morenoa, Rafael Touriñoa, Manel Casellase, Dolors Gradosf,
Corresponding author
mgrados@csa.cat

Corresponding author.
, Grup de Treball de Societat Catalana de Reumatologia FEMCAT
a Rheumatology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
b Pediatric Allergy and Clinical Immunology Department, Clinical Immunology and Primary Immunodeficiencies Unit, Hospital Sant Joan de Déu, Barcelona, Spain
c Study Group for Immune Dysfunction Diseases in Children, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
d Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, University of Barcelona, Barcelona, Spain
e High Risk Obstetric Unit, Gynecology and Obstetrics Department, Vall de Hebron Hospital Campus, Universitat Autónoma of Barcelona (UAB), Barcelona, Spain
f Rheumatology Department, Hospital Universitari d’Igualada, Consorci Sanitari Anoia, Barcelona, Spain
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Table 1. Compatibility of drug treatments during preconception, pregnancy, and lactation.
Abstract
Objective

To design a care protocol in Chronic Inflammatory Arthritis during the pre-conceptional period, pregnancy, postpartum and lactation. This protocol aims to be practical and applicable in consultations where patients with chronic inflammatory rheumatological diseases are treated, thus helping to better control these patients. Likewise, recommendations are offered on when patients could be consulted/referred to a specialized center by the physician.

Methods

A multidisciplinary panel of expert physicians from different specialties identified the key points, analyzed the scientific evidence, and met to develop the care protocol.

Results

The recommendations prepared have been divided into three blocks: rheumatology, gynecology and pediatrics. The first block has been divided into pre-pregnancy, pregnancy and postpartum visits.

Conclusions

This protocol tries to homogenize the follow-up of the patients from the moment of the gestational desire until the year of life of the infants. It is important to perform tests in patients of childbearing age and use drugs compatible with pregnancy. If appropriate, the patient should be referred to specialized units. Multidisciplinarity (rheumatology, gynecology and pediatrics) is essential to improve the control and monitoring of these patients and their offspring.

Keywords:
Arthritis
Pregnancy
Rheumatic disease
Breastfeeding
Prescribing
Corticosteroids
DMARDs, Biologics
Resumen
Objetivo

Diseñar un protocolo asistencial en las Artritis Inflamatorias Crónicas durante el período preconcepcional, el embarazo, el postparto y la lactancia. Este protocolo tiene como objetivo ser práctico y aplicable en las consultas donde se atienden a pacientes con enfermedades inflamatorias reumatológicas crónicas, ayudando así a un mejor control de estas pacientes. Asimismo, se ofrecen recomendaciones sobre en qué momento se podría consultar/remitir a las pacientes a un centro especializado por parte del facultativo.

Métodos

Un panel multidisciplinar de médicos expertos de diferentes especialidades identificó los puntos claves, analizó la evidencia científica y se reunió para elaborar el protocolo asistencial.

Resultados

Las recomendaciones elaboradas se han dividido en tres bloques: reumatología, ginecología y pediatría. El primer bloque se ha dividido en visita pregestacional, gestación y postparto.

Conclusiones

Este protocolo intenta homogeneizar el seguimiento de las pacientes desde el momento del deseo gestacional hasta el año de vida de los lactantes. Es importante realizar análisis en las pacientes en edad fértil y usar fármacos compatibles con la gestación. Si procede, se debe derivar a la paciente a unidades especializadas. La multidisciplinariedad (reumatología, ginecología y pediatría) es fundamental para mejorar en el control y seguimiento de estas pacientes y sus recién nacidos.

Palabras clave:
Artritis
Embarazo
Enfermedades reumatológicas
Lactancia
Prescripción
Glucocorticoides
FAME
Biologico

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