What should be considered before initiating therapy in pregnant patients with rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Before therapy is initiated, patients should be counseled about the teratogenicity and adverse effects of the medications used to treat RA. NSAIDs should be avoided in the third trimester. MTX is contraindicated in pregnancy, because it is an abortifacient and has teratogenic effects, including craniofacial abnormalities, limb defects, and central nervous system (CNS) defects such as anencephaly, hydrocephaly, and meningomyelopathy, especially with first-trimester exposure. [141] Leflunomide is also contraindicated. Both MTX and leflunomide should be discontinued at least 3 months before pregnancy, and blood levels of leflunomide should be assessed.


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