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Rheumatoid ArthritisArrow
Interview 58  

Interview 58

Sex: Male
Background: Robert Moots, Professor of Rheumatology, School of Clinical Sciences at the University of Liverpool and Consultant Rheumatologist at University Hospital Aintree, Liverpool.
Brief outline:Robert Moots, Professor of Rheumatology, School of Clinical Sciences at the University of Liverpool and Consultant Rheumatologist at University Hospital Aintree, Liverpool.


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Professor Robert Moots advices and informs about biologic drugs and pregnancy.

 



It's very important that we think about how these biologic drugs can have an impact on our lives. I think the important thing to remember is that rheumatoid arthritis is much more common in women, and in many women pregnancy is clearly an issue to consider. Obviously if one wishes to get pregnant and to go through pregnancy, the absolutely safest way is to not be on any drugs at all. On the other hand, we know that bad rheumatoid arthritis can make it very hard to become pregnant. And there's a variety of reasons for this. So it's important to consider how we might manage pregnancy in patients with bad rheumatoid arthritis, and the biologic drugs can be very helpful for this. 

First of all, if a woman wants to become pregnant it's important to get the disease as well controlled as possible. And this might involve using a TNF blocker. Once the disease has become well controlled, then it's probably safe to try and get pregnant. But clearly during the pregnancy we want to try and avoid taking drugs where possible. So we tend not to recommend having a TNF blocker during pregnancy. But on the other hand, there are many women that have got pregnant on a TNF blocker and who've ended up staying on the drug through pregnancy without any problems either to them or to the baby. So whilst we think it probably will end up to be okay staying on these drugs through pregnancy, it's clearly premature to say that it really is safe. So we would recommend that you'd stop the drug either as soon as you realised you'd got pregnant or ideally just before you conceived. If you end up getting pregnant whilst taking it, then clearly it's important you discuss this with your rheumatologist. 

For rituximab it's probably a similar situation. But as we don't have quite the same experience we would tend to recommend that women don't get pregnant when they've had a cycle of this until it's washed out of the system. I think the other thing that's very important to remember is that all of the biologic drugs work even better when they're given together with methotrexate. Now methotrexate is a drug that we clearly want to avoid in pregnancy. So that's another reason why if you're wishing to get pregnant it's important to think about in advance, and I think ideally to plan this with advice from your rheumatologist, who'll be in a good position to help you.
Rheumatoid arthritis
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