Thread by @PanktiMehta24

The prevalence of #rheumatoidarthritis 🌍 ~1%

🙀 So ~14 million suffer from RA!

So we 👩‍⚕️ have to deal with special situations while managing this fairly common disease!

#MedTwitter #MedEd #rheumatology #RheumTwitter

@MedTweetorials @nihardesai7

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Let's begin with one of the most beautiful miracles of life ☺️

#pregnancy in #rheumatoidarthritis

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🤔Is it safe to conceive for a patient with RA? 🤰

👉Overall it is safe ☑️☑️☑️

👉But a mild risk of hypertensive disorders, IUGR and need for caesarian section +!

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🤔 What happens to arthritis during pregnancy?

😣 10-15%

😁 48-60%

😕 25-40%

#MedTwitter #MedEd

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🤷What to do about the 💊?

🚫Methotrexate 1-3months prior
🚫Leflunomide, check levels sos cholestyramine washout
🚫TNFis, NSAIDs in the 3rd trimester (except certolizumab)
🚫Rituximab,TCZ at conception

✅Sulfasalazine
✅Hydroxychloroquine
✅AZA

🚥 Steorids ✅ if <20mg

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What about lactation??? 🍼👨‍🍼

All safe except

🚫 Methotrexate
🚫 Leflunomide

Amongst NSAIDS, ibuprofen is preferred!

#MedTwitter

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♂️Hey we forgot about men with RA trying to father a child!

✅ Hydroxychloroquine
✅ AZA
✅ TNFis
✅ Rituximab
✅ Methotrexate
✅ Leflunomide

? JAKibs and Abatacept
rheumatology.org/Portals/0/File…

#MedTwitter

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Few more takeaways from 🇬🇧 2022 guidelines

doi.org/10.1093/rheuma…

🔸🚫sulfasalazine in males if conception delayed by 12 months
🔸vaccination schedule of the infant needs to modified if TNFis continued during 🤰( inflix, adali, etanercept)
Stop JAKibs >2 weeks prior♀️

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What happens to the disease activity post pregnancy?🍼👨‍🍼

😣😣😣 39-50% flare withing 6 months postpartum!

So overall

🔸Pregnancy is safe 🤰☺️
🔸💊 Modifications are needed
🔸 Regular follow-up is a must ⚕️
#MedTwitter #RheumTwitter

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