Rheumatoid Arthritis and Fertile Female: A Comprehensive Review of Management During Pre-Conception, Gestation and Lactation.
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disorder that causes significant physical disability, and it affects women three times more commonly than men. It is often seen in their childbearing years. Data on the annual incidence of the disease also suggests a very high percentage in the child-bearing age group. So understanding their problems and finding a solution will be critical for a health care professional taking care of them. Decisions about parenthood also become challenging, as they are affected by perceptions of their disease state, health care needs, and complex pharmacological treatments. There is undoubtedly a clear need to support these vulnerable women through this important period of their lives. The management of RA has revolutionized in recent years. The availability of novel therapies, such as biological agents and treatment paradigms, has substantially improved treatment outcomes for patients with RA. Unfortunately, data on the safety of many of these medications is limited, and many may be contraindicated during pregnancy and breastfeeding. To stabilize the disease before conception and to modify the drug regime, coordinated and careful planning is needed. Recent studies showed that only 20–40% of patients with RA achieve remission by the third trimester. Although 50% may be considered to have low disease activity, nearly 20% will have worse or moderate-to-high disease activity during pregnancy and may require further therapeutic intervention. Many women commonly report postpartum relapses, making them unable to properly care for themselves and their children. A lot of women can find it difficult to access information that could help them plan for pregnancy, lactation, and early parenting concerning their chronic conditions. The accessibility and variety of the pharmacotherapeutic agents support disease control optimization before conception and contribute to the success of the female raising of children, but they should be provided with a detailed understanding of their risks and safety in the setting of pregnancy and breastfeeding. It is a hard nut to crack for healthcare providers to use individualized treatment plans not only for treating active disease but also for maintaining disease remission during the period of preconception, pregnancy, and postpartum. Through the review, we are trying to identify the various issues that rheumatologists face in taking care of women and men in the reproductive age group who wish to start a family. In addition, it explores evidence-based approaches and emphasizes the safe use of disease-modifying antirheumatic drugs and biologics in the care of pregnant and lactating women with RA.