title: Treatment of rheumatoid arthritis during pregnancy: present and future.
abstract: BACKGROUND
  For the management of rheumatoid arthritis patients who plan to become pregnant, both disease activity and therapeutic regimens have to be taken into consideration. In the case of stable inactive disease, pregnancy can be planned and therapy can be adjusted with drugs compatible with pregnancy.
  
  
  METHODS
  Drugs to be discontinued before pregnancy are methotrexate, leflunomide, tocilizumab, rituximab, abatacept and tofacitinib. Pregnancy compatible disease modifying drugs are antimalarial drugs and sulfasalazine. TNF-inhibitors can be continued during the first half of pregnancy, yet if indicated during the third trimester TNF-inhibitors with a low rate of transplacental passage should be used. Glucocorticoids may be considered at the lowest effective dose throughout pregnancy. Non-selective COX-inhibitors can be continued until gestational week 32. Expert commentary: Together, a tailored treatment throughout pregnancy is possible with reasonable safety. Controlling disease activity during pregnancy is important for both, maternal and fetal health.
authors.affiliation: a Department of Rheumatology, Immunology and Allergology , University Hospital, and University of Bern , Bern , Switzerland.
authors.forename: Frauke
authors.initials: F
authors.lastname: Förger
authors.affiliation: a Department of Rheumatology, Immunology and Allergology , University Hospital, and University of Bern , Bern , Switzerland.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Villiger
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008991:Monitoring, Physiologic; D057285:Precision Medicine; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha
keywords: DMARD; Pregnancy; TNF blockers; biologic agents; rheumatoid arthritis