Management of rheumatic disease during pregnancy starts with prepregnancy counselling.Assessment of maternal and fetal risks is necessary for adjusting therapy before and during pregnancy. The aim of therapy is to keep the disease in remission or at least at low activity throughout pregnancy.
Immunosuppressive drugs requiring withdrawal before conception are methotrexate, cyclophosphamide,and mycophenolate which are known teratogenic drugs. Other drugs like leflunomide, tofacitinib and several biological should be discontinued because pregnancy experience is at present insufficient and safety for the fetus has not been proven.Flares of rheumatic disease showing be treated immediately and with pregnancy compatible drugs.For patients with inflammatory arthritis like rheumatoid arthritis,spondyloarthritis and juvenile idioipathic arthritis disease activity during pregnancy can be controlled with antimalarials, sulfasalazine and TNF inhibitors. Women with systemic lupus erythematosus should continue basic therapy with hydroxychloroquine, and azathioprine, ciclosporine or tacrolimus added when necessary due to organ manifestations. Severe flares during pregnancy may require biologics like rituximab,abatacept,tocilizumab or Anakonda, in SLE corticoid pulses or, if life threatening, intravenous gamma globulin or cyclophosphamide.
Treatment during pregnancy demands balancing suppression of maternal disease and no harm to the child. Selecting the adequate type, the right dose and the right timing of medications for optimal care of pregnant patients remains a challenge.
Disclosure of Interest None declared