TRUDNOĆA U BOLESNICE S REUMATOIDNIM ARTRITISOM LIJEČENE METOTREKSATOM I INFLIKSIMABOM

Marija Bakula, Mislav Cerovec, Krešimir Rukavina, Nada Čikeš, Branimir Anić

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.

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.