Sex Hormones and Rheumatoid Factor : a Possible Link Between Reproductive Hormones Patterns and the Onset of Rheumatoid Arthritis Among Women in

Daniel Aletaha, Tuhina Neogi, Alan J. Silman, Julia Funovits, David T. Felson, Clifton O. Bingham, Neal S. Birnbaum, Gerd R. Burmester, Vivian P. Bykerk, Marc D. Cohen, Bernard Combe, Karen H. Costenbader, Maxime Dougados, Paul Emery, Gianfranco Ferraccioli, Johanna M.W. Hazes, Kathryn Hobbs, Tom W.J. Huizinga, Arthur Kavanaugh, Jonathan KayTore K. Kvien, Timothy Laing, Philip Mease, Henri A. Ménard, Larry W. Moreland, Raymond L. Naden, Theodore Pincus, Josef S. Smolen, Ewa Stanislawska-Biernat, Deborah Symmons, Paul P. Tak, Katherine S. Upchurch, Jiří Vencovský, Frederick Wolfe, Gillian Hawker, Amir I. Elshafie, Abdalla D. Elkhalifa, Sahwa Elbagir, Mawahib I.E. Aledrissy, Elnour M. Elagib, Musa A.M. Nur, Tomas Weitoft, Johan Rönnelid, Tosoh Bioscience, Olga L. Quintero, Manuel J. Amador-Patarroyo, Gladys Montoya-Ortiz, Adriana Rojas-Villarraga, Juan Manuel Anaya, Shahar Shelly, Mona Boaz, Hedi Orbach, Sandeep K. Agarwal, Michael J Wheeler, Mahin Lashkari, Akram Noori, Sonia Oveisi, Mohammadreza Kheirkhah, Metabolic Diseases, Child Health, Metabolic Diseases, Metabolic Diseases, Cecilia Engdahl, Albert Bondt, Ulrike Harre, Jasmin Raufer, René Pfeifle, Alessandro Camponeschi, Manfred Wuhrer, Michaela Seeling, Inga Lill Mårtensson, Falk Nimmerjahn, Gerhard Krönke, Hans U. Scherer, Helena Forsblad-d'Elia, Georg Schett, Marina Pierdominici, Angela Maselli, Tania Colasanti, Anna Maria Giammarioli, Federica Delunardo, Davide Vacirca, Massimo Sanchez, Antonello Giovannetti, Walter Malorni, Elena Ortona, Meredith Provost, Jennifer L. Eaton, Megan E.B. Clowse, Jenny Brouwer, Johanna M.W. Hazes, Joop S.E. Laven, Radboud J.E.M. Dolhain, Pascal H.P. de Jong, Radboud J.E.M. Dolhain

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Abstract

Many rheumatic diseases affect women of childbearing age, and the medications used to treat these diseases may affect conception, pregnancy, fetal development, and lactation. Physicians who care for these women need to be aware of the potential adverse effects of these medications, and which medications can be used safely prior to conception and during pregnancy and lactation. Although reviews of individual classes of medications are available, there is no practical and comprehensive review that summarizes all of this information, and includes anticoagulant drugs and 2 recently approved drugs for rheumatoid arthritis. Women who take cytotoxic drugs should be informed of the risks of impaired fertility and congenital malformations, and must use effective methods of contraception. During pregnancy, nonsteroidal anti-inflammatory agents may be used until the last 6 weeks, and low to moderate doses of corticosteroids are safe throughout pregnancy. Among the disease-modifying agents, sulfasalazine and hydroxychloroquine treatment may be maintained. Cytotoxic drugs may be used after the first trimester to treat life-threatening disease. During lactation, prednisone, sulfasalazine, and hydroxychloroquine may be used cautiously. Women using heparin for treatment of antiphospholipid antibody syndrome should take measures to prevent bone loss. Men taking methotrexate, sulfasalazine, cyclosporine, azathioprine, or leflunomide should be apprised of the possibilities of infertility and teratogenicity.

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