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Management of the Pregnant Patient by the Rheumatologist

Bonnie L Bermas, MD

Rheumatic disorders are more common in women. Thus, clinicians may be faced with the challenge of managing a rheumatic disease during pregnancy. The physiological and immunological changes that occur in pregnancy can impact disease symptoms and activity. An integrated team approach that relies on input from the rheumatologist, maternal–fetal medicine specialist, and the patient, is the best insurance for a good outcome. Treatment regimens must be modified as not all medications are compatible with pregnancy. In general, nonsteroidal anti-inflammatory drugs up to the third trimester, glucocorticoids, antimalarials, sulfasalazine, and the immunosuppressive agents azathioprine and cyclosporine A may be used during pregnancy while methotrexate, leflunomide, cyclophosphomide, and the biologics should be avoided. Int J Adv Rheumatol 2011;9(4):115–22.

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