PREGNANT PATIENT WITH RHEUMATOID ARTHRITIS TREATED WITH METHOTREXATE AND INFLIXIMAB

Broj: 1, 2016 Rubrika: Prikaz bolesnika Autori: Marija Bakula, Mislav Cerovec, Krešimir Rukavina, Nada Čikeš, Branimir Anić

Inhibitori faktora nekroze tumora-alfa već se dugi niz godina rabe u liječenju reumatoidnog artritisa. Prema potencijalnoj štetnosti u trudnoći spadaju u skupinu lijekova kategorije „B”. Testiranja na životinjama nisu dokazala njihovu štetnost u trudnoći, a testiranja na ljudima nisu provođena. Vrlo se često u kombinaciji s biološkom terapijom primjenjuju i lijekovi koji modifi ciraju tijek bolesti, od kojih je metotreksat dokazano učinkovit u liječenju
reumatoidnog artritisa. Ovaj antimetabolit spada u skupinu lijekova kategorije „X” s poznatim teratogenim djelovanjem. Incidencija upalnih reumatskih bolesti znatno je veća u žena te do danas postoje brojni prikazi bolesnica liječenih biološkom terapijom, često i kombiniranom s lijekovima koji mijenjaju tijek upalnih reumatskih bolesti, za vrijeme začeća i trudnoće. Štetni utjecaj takve terapije tema je rasprave, često s oprečnim zaključcima. Prikazujemo slučaj bolesnice s reumatoidnim artritisom koja je neplanirano zanijela; trudnoća je otkrivena tek u 31. tjednu, a u tom je
razdoblju kontinuirano liječena metotreksatom i infl iksimabom, bez štetnih utjecaja na razvoj djeteta.

Tumor necrosis factor-alpha inhibitors have become an established therapeutic regimen for patients with rheumatoid arthritis. Regarding their harmful potential they are classifi ed as category B medications. Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Disease-modifying antirheumatic drugs (DMARDs) are oft en used in combination with biological therapy and treatment with methotrexate has shown good results. Th is antimetabolite is classifi ed as a category X drug and its teratogenic eff ect is well known. Th e incidence of infl ammatory rheumatic diseases is signifi – cantly higher in women. Th ere are many reports on pregnant patients treated with biological therapy, oft en in combination with DMARDs. Th e eff ects of such a therapy on reproductive health is a theme of debate, with controversial views on the matter. We present a patient with rheumatoid arthritis whose pregnancy was discovered at 31 weeks of gestation. During that period she had been treated with methotrexate and infl iximab, with no adverse eff ects.

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