类风湿关节炎患者妊娠期、围产期及哺乳期用药策略

Medication strategy for RA patients during pregnancy,perinatal period and lactation

随着新型生物制剂——肿瘤坏死因子抑制剂(TNFi)的广泛应用,更多RA患者病情可得到较好控制,因此有更多RA女性患者提出生育要求。本文总结了当前RA患者妊娠期、围产期及哺乳期相关药物治疗进展,给出了安全用药建议和药物治疗原则。我们建议提高RA育龄女性依从性,采取有计划的妊娠。风湿免疫科医生应当联合产科医生、儿科医生等相关人员,针对RA患者具体情况共同制定合理的个体化治疗方案,保证妊娠期及哺乳期间母子生命健康安全。妊娠期间禁用的药物有甲氨蝶呤(MTX),来氟米特(LEF),阿巴西普(ABA)和利妥昔单抗(RIT)。可应用至妊娠期的药物有肿瘤坏死因子抑制剂(TNFi),双磷酸盐类(BP)。可应用于妊娠期间的控制病情药物有氯喹(CQ)/羟氯喹(HCQ),柳氮磺吡啶(SSZ),硫唑嘌呤(AZA),环孢素A(CsA)。其他妊娠期可应用的药物有皮质类固醇激素(CS),非甾体抗炎药(NSAIDs)。哺乳期能安全切有效控制RA病情的药物有NSAIDs,类固醇激素(Steroids),HCQ,SSZ。

As several kinds of Tumor necrosis factor inhibitors（TNFi） are widely used,more RA patients can get their disease activity well controlled,and consequently,the proportion of women with RA becoming pregnant will increase.We summarize recent progresses on drug therapy for pregnant woman with RA,give recommendations and principles on drug safety during pregnancy and lactation.We suggest that the patients＇ compliance to planning pregnancy is important.Combined with obstetrician and pediatrician,the Rheumatologists should consider the stage and severity of RA when designing individualized drug therapy to ensure the safety of mother and baby through the whole gestation and lactation period.Drugs incompatible with pregnancy are Methotrexate（MTX）,Leflunomide（LEF）,Abatacept（ABA） and Rituximab（RIT）.Drugs suitable for use until conception are Tumor necrosis factor inhibitors（TNFi） and Bisphosphonates（BP）.Disease-modifying antirheumatic drugs（DMARDs） compatible with pregnancy are chloroquine（CQ）/Hydroxychloroquine（HCQ）,Sulfasalazine（SSZ）,Azathioprine（AZA） and Ciclosporin A（CsA）.Other drugs compatible with pregnancy are Corticosteroids（CS） and Nonsteroidal Antiinflammatory Drugs（NSAIDs）.Drugs compatible with lactation are NSAIDs,Steroids,HCQ and SSZ.