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Old 08-09-2011
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Default Rheumatoid Arthritis in pregnancy

What is the best medication for Rheumatoid Arthritis in pregnancy?

1) methotrexate

2) prednisone

3) NSAIDs

4) salicyclate
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Old 08-09-2011
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I m gonna guess and say Prednisone because:
NSAID will close ductus arteriosus
MTX is teratogenic being a folic acid antagonist
Salicylate can cause placental abruption
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Old 08-09-2011
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Quote:
Originally Posted by aghammoud85 View Post
What is the best medication for Rheumatoid Arthritis in pregnancy?

1) methotrexate

2) prednisone

3) NSAIDs

4) salicyclate
2) prednisone!

MTX is absolutely contraindicated and NSAID's are pregnancy class "C" drugs.
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Old 08-26-2011
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Prednisone
Corticosteroids are potent anti-inflammatory agents. They are considered relatively safe in pregnancy when used in low doses and are designated as category B medications. Nonetheless, corticosteroids may increase the maternal risk of hypertension, edema, gestational diabetes, osteoporosis, premature rupture of membranes, and small-for-gestational-age babies.

One meta-analysis found a 3.5-fold increase in the risk of cleft palate in fetuses with first-trimester exposure to corticosteroids.

The choice of glucocorticoid depends on whether the mother or the fetus needs to be treated. Hydrocortisone and cortisone cross the placenta, but 11 beta-dehydrogenase, a placental enzyme, converts hydrocortisone to cortisone, which is biologically inactive; thus, the fetus is exposed to only approximately 10% of the maternal dose. Therefore, if steroid treatment is desired for the mother, hydrocortisone, cortisone, or prednisone should be chosen.

Dexamethasone and betamethasone cross the placenta with similar maternal and fetal concentrations; thus, they are the treatment of choice for fetal respiratory distress.

The lowest possible steroid dose needed to control disease activity should be used in pregnancy. Stress doses of steroids should be used during labor and delivery if the mother received steroids (even low-dose) for more than 2-3 weeks during pregnancy, and the neonate should be monitored for evidence of adrenal insufficiency and infection.
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