FEATURES OF THE COURSE OF RHEUMATOID ARTHRITIS IN PREGNANT WOMEN
Keywords:
rheumatoid arthritis, pregnancy, RA activity, methylprednisolone, disease-modifying antirheumatic drugs (DMARDs).Abstract
Introduction. Rheumatoid arthritis (RA) is a chronic autoimmune disease of connective tissue that predominantly affects women of childbearing age. The development of this condition in women of reproductive age has sparked interest in studying the issue of pregnancy in patients with rheumatoid arthritis.
Objective. To assess the dynamics of RA activity using the DAS28-ESR score during pregnancy and after childbirth.
Material and Methods. A total of 13 pregnancies in women with confirmed RA were monitored. The patients were examined at both pre-hospital and hospital stages at various gestational ages and during the postpartum period.
Results. A total of 13 women with confirmed RA were included in the study. Among them, 12 patients (92.3%) were seropositive for rheumatoid factor (RF), and 12 patients (92.3%) were seropositive for anti-cyclic citrullinated peptide antibodies (anti-CCP). Eleven patients (84.6%) had radiological stage II or III RA, and 12 (92.3%) were classified as functional class I or II.
Ten patients (76.9%) received disease-modifying antirheumatic drugs (DMARDs), and 8 (61.5%) women received glucocorticoid therapy (GC) at conception.
All patients were enrolled in the study when they sought medical care for RA, and pregnancy was diagnosed simultaneously. None of the patients were in remission at enrollment.
During pregnancy, all 13 patients with RA received methylprednisolone with DMARDs such as sulfasalazine and hydroxychloroquine. Three patients received GC only.
After childbirth, due to increased disease activity, 6 patients required glucocorticoids in combination with methotrexate, leflunomide, and sulfasalazine.
Discussion. The study did not reveal a decrease in RA during pregnancy, as reported by other authors. Remission of RA was not observed in this study.
All pregnant patients received GC, which contributed to favorable pregnancy outcomes.
Eight patients were monitored postpartum; 6 of them experienced a flare of RA, manifested as an exacerbation of joint symptoms, while two patients remained in stable condition.
Most pregnancies were unplanned; the patients were not prepared for pregnancy and received the disease-modifying therapy irregularly.
Conclusions:
1. No decrease in RA was observed during pregnancy.
2. All pregnant patients with RA were unprepared for pregnancy, which occurred spontaneously without preconception planning.
3. Disease-modifying therapy was taken irregularly.
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