I. Drugs that should be discontinued before pregnancy
1. Methotrexate: Discontinue it 3 months before pregnancy and prohibit it during pregnancy. After discontinuing methotrexate, consider pregnancy at least after the next menstrual period, and folic acid supplementation is recommended before and during pregnancy.
2. Leflunomide: Discontinue 2 years prior to planned pregnancy. Prior to planned pregnancy or unplanned pregnancy during treatment, rapid cleansing of the active metabolites of leflunomide with abciximide.
3. Rituximab (melphalan): a human-mouse chimeric monoclonal antibody targeting CD20 antigen expressed on mature B cells and B cell precursors. Discontinue use 1 year before planned pregnancy. Jiang Qiaoyan, Department of Traditional Chinese Medicine, Sanming Second Hospital
4. (Abciap): a selective T-cell co-stimulatory regulator that blocks key signals in the T-cell activation co-stimulation pathway to inhibit and reverse the inflammatory process. It is discontinued 10 weeks before planned pregnancy.
Second, drugs that should be discontinued at the time of pregnancy
1.Anti-TNF biologics (class gram, Ixepro, adalimumab): It is not clear whether TNF antagonist treatment has long-term effects on the fetus, and should be discontinued as soon as pregnancy is established.
2. Bisphosphonates (Fosamax, Gupta, etc.): Intravenous bisphosphonates can cause fetal hypocalcemia and should be used with caution during pregnancy. Because there is no follow-up result of long-term effects on infants, any type of bisphosphonates should be discontinued once pregnancy is established.
Third, the drugs available in pregnancy
1. Chloroquine phosphate and hydroxychloroquine: they are safe for the fetus. Since more cases of hydroxychloroquine than chloroquine phosphate have been observed during pregnancy, and the concentration in maternal tissues is lower in the former than in the latter, it is better to take hydroxychloroquine than chloroquine phosphate during pregnancy.
2.Lyuzosulfapyridine: it can be used during pregnancy, but it needs to be supplemented with folic acid.
3. Azathioprine: It can be used during pregnancy, but the dose should be less than 2mg/kg.d. If the dose is high, there is a risk of suppressed fetal erythropoiesis.
4.Cyclosporine A: 2.5-5.0mg/kg.d d dose of cyclosporine can be taken during pregnancy.
5.Hormone: oral prednisone or intra-articular injection of hormone can be taken. However, the minimum dose should be used during the first 3 months of pregnancy (to avoid increasing the risk of orofacial fracture). Long-term hormone users need to increase the dose appropriately in the perinatal period.
6.Non-steroidal anti-inflammatory drugs: drugs with a short half-life such as lexapro are preferred during the first 32 weeks of pregnancy. After 7 months of pregnancy, the use of such drugs should be stopped. It is best to intermittently take the lowest effective dose of NSAIDs to reduce the risk of adverse fetal reactions.
IV. Treatment options for exacerbations in pregnancy
Patients with acute arthritis exacerbations during pregnancy can occur. The following methods are available.
1. more than one arthritis: intra-articular hormone injections can be given along with oral NSAIDs (including fotarine, ibuprofen, naproxen, etc.), and it should be noted that they should be discontinued at 32 weeks of pregnancy.
2.Only joint pain: paracetamol can be used, 1-4g/day is a safe dose.
3, systemic symptoms: oral small doses of hormones, while adjusting second-line drug therapy.