Información del artículo
Abstract
Rheumatoid arthritis is a disease that is highly prevalent in women of childbearing age. A review is done about the characteristics of the placental barrier, the passage of drugs through it and the use of drugs during pregnancy: those which are potentially safe drugs, those drugs that can only be used if there is a life threatening condition for the mother, drugs that are contraindicated and those with insufficient data on safety and therefore should be avoided, the latter group comprises biological drugs. Also a review is done about the use of drugs during lactation, a period that a flare of rheumatoid arthritis can occur.
Keywords:
Rheumatoid arthritis
Immunosuppressive agents
Pregnancy
Lactation
Resumen
La artritis reumatoide es una enfermedad que tiene una alta prevalencia en mujeres en edad fértil. Se realiza una revisión de las características de la barrera placentaria, el paso de medicamentos a través de ella y del uso de fármacos durante el embarazo: los que son potencialmente seguros, los fármacos que sólo pueden ser usados si la vida materna se ve comprometida, los fármacos que están contraindicados y aquellos con información insuficiente sobre seguridad y que por tanto deben ser evitados, en este último grupo se ubican los fármacos biológicos. También se realiza una revisión acerca del uso de fármacos durante la lactancia, periodo en el cual es frecuente un rebrote de la artritis reumatoide.
Palabras clave:
Artritis reumatoide
Inmunosupresores
Embarazo
Lactancia
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References
[1.]
Bernas BL. Rheumatoid arthritis and pregnancy. En UpToDate, Rose BD, editor. UpToDate. Waltham, MA; 2010.
[2.]
J. Barrett, P. Brennan, M. Fiddler, A.J. Silman.
Does Rheumatoid arthritis remit during pregnancy and relapse postpartum?.
Arthritis Rheum, 45 (1999), pp. 1219-1227
[3.]
Y.A. De Man, R.J. Dolhain, F.E. Van de Geijn, S.P. Willemsen, J.M. Hazes.
Disease activity of rheumatoid arthritis during pregnancy: Results from a Nationwide Prospective Study.
Arthritis Rheum, 59 (2008), pp. 1241-1248
[4.]
M. Østensen, F. Förger.
Management of RA medications in pregnant patients.
Nat Rev Rheumatol, 5 (2009), pp. 382-390
[5.]
M. Gayed, C. Gordon.
Pregnancy and rheumatic diseases.
Rheumatology, 46 (2007), pp. 1634-1640
[6.]
M. Østensen, F. Forger, J.L. Nelson, A. Schuhmacher, G. Hebisch, P.M. Villiger.
Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post partum.
Ann Rheum Dis, 64 (2005), pp. 839-844
[7.]
J.L. Nelson, A. Kathleen, B.S. Hughes, G.S. Anajane, M.A. Smith, B.B. Nisperos, et al.
Maternal-fetal disparity in HLA class II alloantigens and the pregnancy-induced amelioration of rheumatoid arthritis.
N Engl J Med, 329 (1993), pp. 466-471
[8.]
M. Purizaca-Benites.
La placenta y la barrera placentaria.
Rev Per Ginecol Obstet, 54 (2008), pp. 270-278
[9.]
A.C. Guyton, J.E. Hall.
Embarazo y lactancia.
Tratado de fisiología médica, 11th ed., pp. 1027-1041
[10.]
E.M. Ostrea, J.B. Mantaring, M.A. Silvestre.
Drugs that affect the fetus and newborn infant via the placenta or breast milk.
Pediatr Clin North Am, 51 (2004), pp. 539-579
[11.]
Hunt JS. Immunology of the maternal-fetal interface. In: UpToDate, Rose BD, editor. UpToDate. Waltham, MA; 2010.
[12.]
C.P. Torfs, E.A. Katz, T.F. Bateson, P.K. Lam, C.J. Curry.
Maternal medications and environmental exposures as risk factors for gastroschisis.
Teratology, 54 (1996), pp. 84-92
[13.]
A. Ericson, B.A.J. Källén.
Nonsteroidal anti-inflammatory drugs in early pregnancy.
Reproductive Toxicology, 15 (2001), pp. 371-375
[14.]
J. Calvo Allen.
Tratamiento de situaciones clínicas difíciles en pacientes con artritis reumatoide: embarazo.
Reumatol Clin, 5 (2009), pp. 48-52
[15.]
A. Cetinkal, A. Colak, K. Topuz, M.N. Demircan, H. Simsek, U. Berber, et al.
The effects of meloxicam on neural tube development in the early stage of chick embryos.
Turk Neurosurg, 20 (2010), pp. 111-116
[16.]
Bernas BL. Use of immunosuppressive drugs in pregnancy and lactation. In: UpToDate, Rose BD, editor. UpToDate. Waltham, MA; 2010.
[17.]
L. Park-Wyllie, P. Mazzotta, A. Pastuszak, M.E. Moretti, L. Beique, L. Hunnisett, et al.
Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies.
Teratology, 62 (2000), pp. 385-392
[18.]
S. Hernandez-Díaz, M.M. Werler, A.M. Walker, A.A. Mitchell.
Folic acid antagonists during pregnancy and the risk of birth defects.
N Engl J Med, 343 (2000), pp. 1608-1614
[19.]
M. Østensen, M. Khamashta, M. Lockshin, A. Parke, A. Brucato, H. Carp, et al.
Antiinflammatory and immunosuppressive drugs and reproduction.
Arthritis Res Ther, 8 (2006), pp. 209-228
[20.]
C.O. Moráin, P. Smethurst, C.J. Doré, A.J. Levi.
Reversible male infertility due to sulphasalazine: studies in man and rat.
Gut, 25 (1984), pp. 1078-1084
[21.]
N. Costedoat-Chalumeau, Z. Amoura, P. Duhaut, D.L.T. Huong, D. Sebbough, B. Wechsler, et al.
Safety of hydroxychloroquine in pregnant patients with connective tissue diseases. A study of one hundred thirty-three cases compared with a control group.
Arthritis Rheum, 48 (2003), pp. 3207-3211
[22.]
B. Nørgård, L. Pedersen, L.A. Christensen, H.T. Sørensen.
Therapeutic drug use in women with Crohn's disease and birth outcomes: a Danish nationwide cohort study.
Am J Gastroenterol, 102 (2007), pp. 1406-1413
[23.]
V.T. Armenti, K.M. Ahlswede, B.A. Ahlswede, B.E. Jarrell, M.J. Moritz, J.F. Burke.
National transplantation Pregnancy Registry--outcomes of 154 pregnancies in cyclosporinetreated female kidney transplant recipients.
Transplantation, 57 (1994), pp. 502-506
[24.]
A. Kainz, I. Harabacz, I.S. Cowlrick, S.D. Gadgil, D. Hagiwara.
Review of the course and outcome of 100 pregnancies in 84 women treated with tacrolimus.
Transplantation, 70 (2000), pp. 1718-1721
[25.]
D. Paladini, M. Vassallo, M.R. D’Armiento, B. Cianciaruso, P. Martinelli.
Prenatal detection of multiple fetal anomalies following inadvertent exposure to cyclophosphamide in the first trimester of pregnancy.
Birth Defects Res A Clin Mol Teratol, 70 (2004), pp. 99-100
[26.]
M. Almarzouqi, D. Scarsbrook, A. Klinkhoff.
Gold therapy in women planning pregnancy: Outcomes in One Center.
J Rheumatol, 34 (2007), pp. 1827-1831
[27.]
C.D. Chambers, D.L. Johnson, L.K. Robinson, S.R. Braddock, R. Xu, J. Lopez-Jimenez, et al.
Birth outcomes in women who have taken leflunomide during pregnancy.
Arthritis Rheum, 62 (2010), pp. 1494-1503
[28.]
A. Pérez-Aytes, A. Ledo, V. Boso, P. Sáenz, E. Roma, J.L. Poveda, et al.
In utero exposure to mycophenolate mofetil: A characteristic phenotype?.
Am J Med Genet A, 146A (2008), pp. 1-7
[29.]
I. Pache, G. Rogler, Ch. Felley.
TNF-a blockers in inflammatory bowel disease: Practical consensus recommendations and user's guide.
Swiss Med Wkly, 139 (2009), pp. 278-287
[30.]
C. Roux, O. Brocq, V. Breuil, C. Albert, L. Euller-Ziegler.
Pregnancy in rheumatology patients exposed to anti-tumour necrosis factor (TNF)-a therapy.
Rheumatology, 46 (2007), pp. 695-698
[31.]
Y.M. Ali, B. Kuriya, C. Orozco, J.J. Cush, E.C. Keystone.
Can tumor necrosis factor inhibitors be safely used in pregnancy?.
J Rheumatol, 37 (2010), pp. 9-17
[32.]
N. Umeda, S. Ito, T. Hayashi, D. Goto, I. Matsumoto, T. Sumida.
A patient with rheumatoid arthritis who had a normal delivery under etanercept treatment.
Inter Med, 49 (2010), pp. 187-189
[33.]
J.A. Katz, C. Antoni, G.F. Keenan, D.E. Smith, S.J. Jacobs, G.R. Lichtenstein.
Outcome of pregnancy in women receiving infliximab for the treatment of Crohn's disease and rheumatoid arthritis.
Am J Gastroenterol, 99 (2004), pp. 2385-2392
[34.]
M. Østensen, M. Lockshin, A. Doria, G. Valesini, P. Meroni, C. Gordon, et al.
Update on safety during pregnancy of biological agents and some immunosuppressive antirheumatic drugs.
Rheumatology, 47 (2008), pp. iii28-iii31
[35.]
A. Oussalah, M.A. Bigard, L. Peyrin-Biroulet.
Certolizumab use in pregnancy.
Gut, 58 (2009), pp. 608
[36.]
E. Vinet, C. Pineau, C. Gordon, A.E. Clarke, S. Bernatsky.
Biologic therapy and pregnancy outcomes in women with rheumatic diseases.
Arthritis Rheum, 61 (2009), pp. 587-592
[37.]
K.F. Ilett, J.H. Kristensen.
Drug distribution in human milk.
Aust Prescr, 20 (1997), pp. 35-40
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