风湿

抗TNF生物制剂等可用于孕期和哺乳期的类风湿患者

作者:Murray KE ,et al. 翻译:北医三院赵金霞 审校:柴静 来源:中国风湿病公众论坛 日期:2018-06-07
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         抗TNF生物制剂等可用于孕期和哺乳期的类风湿患者

关键字:  抗TNF生物制剂 

        摘要:背景:类风湿关节炎(RA)是一种慢性免疫介导的炎症性疾病,可导致严重残疾、并发症、死亡和生育能力受损。该病常发生于育龄期女性。给围产期类风湿关节炎(RA)的治疗带来了挑战。许多传统改善病情抗风湿药物(DMADS)和越来越多的新的治疗药物在妊娠和哺乳期的数据有限,这些药物的致畸作用受到关注。目的:本研究的目的是针对在我们新成立的风湿病和生殖健康服务体系就医的RA患者建立一个标准化的药物管理方法。方法:我们回顾了有关在妊娠期使用抗风湿药物的相关文献。包括来自英国风湿病学会(BSR)和英国风湿病卫生专业人员(BHPR)和欧洲抗风湿病联盟(EURAR)制定的最新指南。结果:在参考相关出文献之后,我们开发了圣文森特大学医院/国家妇产医院在RA中基于循证医学的用药共识。结论:RA患者趋于在怀孕期间病情改善,而产后病情易复发。目前有几种抗风湿药物在怀孕和哺乳期可供选择,包括抗肿瘤坏死因子(抗TNF)药物。在生育的各个阶段良好的疾病控制对于确保母婴的最佳结局至关重要。

        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]

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