Last update: Aug. 15, 2019

Maternal Rheumatoid arthritis (RA)

Low Risk for breastfeeding


Moderately safe. Probably compatible.
Mild risk possible. Follow up recommended.
Read the Comment.

Enfermedad autoinmune en la que el propio sistema inmunitario ataca por error a células y tejidos, pudiendo dañar sobre todo las articulaciones, pero también el corazón, la piel, los ojos, los pulmones y las arterias y venas.
Es más frecuente en mujeres que en hombres. La enfermedad suele cursar en forma de brotes con periodos intermedios sin síntomas. El tabaquismo es un factor desencadenante importante.

Alrededor de la mitad de mujeres con artritis reumatoide activa mejoran con el embarazo y la mayoría vuelven a recaer en los primeros meses del postparto dificultándoles el cuidado de su bebé y la lactancia (Bermas 2017 de Jong 2017, Krause 2016, Østensen 2007).
Algunos estudios encontraron más riesgo de recidivas con la lactancia, en especial en primer embarazo (Vieira 2019). Se han encontrado niveles elevados de prolactina en enfermos de artritis reumatoide (Wu 2019)
Se ha encontrado menor riesgo de artritis posterior en mujeres que han amamantado (Orellana 2017, Chen 2015)
Haber sido amamantado disminuye el riesgo de padecer artritis reumatoide (Colebatch 2011, Young 2007, Jacobsson 2003, ).

Autores expertos y sociedades médicas de Reumatología consultadas no contraindican la lactancia sino que abogan por elegir cuidadosamente los fármacos antiinflamatorios e inmunosupresores (Paizis 2019, Anderson 2019, Bermas 2017, de Jong 2017, Krause 2016, Ngian 2016, Götestam-EULAR 2016, Flint 2106, Kavanaugh 2015, Sammaritano 2014, Makol 2011, Weber 2008, Østensen 2009, 2008 y 2007, Needs 1985).

Ibuprofeno, paracetamol, hidroxicloroquina, corticosteroides, ciclosporina, sulfasalazina y metotrexato a dosis de hasta 25 mg semanales son seguras (Thorne 2014). Entre los anticuerpos monoclonales contra el factor de necrosis tumoral (antiTNF) adalimumab, certolizumab e infliximab son seguros durante la lactancia por no excretarse en leche materna. No hay datos hasta la fecha para considerar seguros los inhibidores de la quinasa Janus como el Baricitinib y el Tofacitinib (Anderson 2018 y 2016, de Jong 2017).

Suggestions made at e-lactancia are done by APILAM´s pediatricians and pharmacists, and are based on updated scientific publications.
It is not intended to replace the relationship you have with your doctor but to compound it.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Maternal Rheumatoid arthritis (RA) belongs to this group or family:

References

  1. Wu Q, Dan YL, Zhao CN, Mao YM, Liu LN, Li XM, Wang DG, Pan HF. Circulating levels of prolactin are elevated in patients with rheumatoid arthritis: a meta-analysis. Postgrad Med. 2019 Mar;131(2):156-162. Abstract
  2. Vieira Borba V, Shoenfeld Y. Prolactin, autoimmunity, and motherhood: when should women avoid breastfeeding? Clin Rheumatol. 2019 May;38(5):1263-1270. Abstract
  3. Paizis K. Immunomodulatory drugs in pregnancy and lactation. Aust Prescr. 2019 Jun;42(3):97-101. Abstract
  4. Anderson PO. Drug Treatment of Rheumatoid Arthritis During Breastfeeding. Breastfeed Med. 2018 Nov;13(9):575-577. Abstract
  5. Morita T, Fujimoto K, Shima Y, Ogata A, Kumanogoh A. Minimal neonatal transfer of certolizumab pegol in a Japanese patient with rheumatoid arthritis. Ann Rheum Dis. 2018 Sep;77(9):e56. Abstract
  6. de Jong PH, Dolhain RJ. Fertility, Pregnancy, and Lactation in Rheumatoid Arthritis. Rheum Dis Clin North Am. 2017 May;43(2):227-237. Abstract
  7. Louthrenoo W, Kasitanon N, Katchamart W, Aiewruengsurat D, Chevaisrakul P, Chiowchanwisawakit P, Dechanuwong P, Hanvivadhanakul P, Mahakkanukrauh A, Manavathongchai S, Muangchan C, Narongroeknawin P, Phumethum V, Siripaitoon B, Suesuwan A, Suwannaroj S, Uea-Areewongsa P, Ukritchon S, Asavatanabodee P, Koolvisoot A, Nanagara R, Totemchokchyakarn K, et al. 2016 updated Thai Rheumatism Association Recommendations for the use of biologic and targeted synthetic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis. Int J Rheum Dis. 2017 Sep;20(9):1166-1184. Abstract
  8. Bermas BL. Lactation and Management of Postpartum Disease. Rheum Dis Clin North Am. 2017 May;43(2):249-262. Abstract
  9. Orellana C, Saevarsdottir S, Klareskog L, Karlson EW, Alfredsson L, Bengtsson C. Oral contraceptives, breastfeeding and the risk of developing rheumatoid arthritis: results from the Swedish EIRA study. Ann Rheum Dis. 2017 Nov;76(11):1845-1852. Abstract
  10. Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I; BSR and BHPR Standards, Guidelines and Audit Working Group.. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II: analgesics and other drugs used in rheumatology practice. Rheumatology (Oxford). 2016 Sep;55(9):1698-702. Abstract Full text (in our servers)
  11. Flint J, Panchal S, Hurrell A, van de Venne M, Gayed M, Schreiber K, Arthanari S, Cunningham J, Flanders L, Moore L, Crossley A, Purushotham N, Desai A, Piper M, Nisar M, Khamashta M, Williams D, Gordon C, Giles I; BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part I: standard and biologic disease modifying anti-rheumatic drugs and corticosteroids. Rheumatology (Oxford). 2016 Sep;55(9):1693-7. Abstract Full text (link to original source) Full text (in our servers)
  12. Götestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, da Silva J, Nelson-Piercy C, Cetin I, Costedoat-Chalumeau N, Dolhain R, Förger F, Khamashta M, Ruiz-Irastorza G, Zink A, Vencovsky J, Cutolo M, Caeyers N, Zumbühl C, Østensen M. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810. Abstract Full text (link to original source) Full text (in our servers)
  13. Anderson PO. Monoclonal Antibodies. Breastfeed Med. 2016 Apr;11:100-1. Abstract
  14. Ngian GS, Briggs AM, Ackerman IN, Van Doornum S. Safety of anti-rheumatic drugs for rheumatoid arthritis in pregnancy and lactation. Int J Rheum Dis. 2016 Sep;19(9):834-43. Abstract
  15. Krause ML, Makol A. Management of rheumatoid arthritis during pregnancy: challenges and solutions. Open Access Rheumatol. 2016 Mar 23;8:23-36. eCollection 2016. Review. Abstract
  16. Chen H, Wang J, Zhou W, Yin H, Wang M. Breastfeeding and Risk of Rheumatoid Arthritis: A Systematic Review and Metaanalysis. J Rheumatol. 2015 Sep;42(9):1563-9. Abstract
  17. Kavanaugh A, Cush JJ, Ahmed MS, Bermas BL, Chakravarty E, Chambers C, Clowse M, Curtis JR, Dao K, Hankins GD, Koren G, Kim SC, Lapteva L, Mahadevan U, Moore T, Nolan M, Ren Z, Sammaritano LR, Seymour S, Weisman MH. Proceedings from the American College of Rheumatology Reproductive Health Summit: the management of fertility, pregnancy, and lactation in women with autoimmune and systemic inflammatory diseases. Arthritis Care Res (Hoboken). 2015 Abstract Full text (link to original source) Full text (in our servers)
  18. Sammaritano LR, Bermas BL. Rheumatoid arthritis medications and lactation. Curr Opin Rheumatol. 2014 Abstract
  19. Thorne JC, Nadarajah T, Moretti M, Ito S. Methotrexate use in a breastfeeding patient with rheumatoid arthritis. J Rheumatol. 2014 Abstract Full text (link to original source) Full text (in our servers)
  20. Makol A, Wright K, Amin S. Rheumatoid arthritis and pregnancy: safety considerations in pharmacological management. Drugs. 2011 Abstract
  21. Colebatch AN, Edwards CJ. The influence of early life factors on the risk of developing rheumatoid arthritis. Clin Exp Immunol. 2011 Jan;163(1):11-6. Abstract
  22. Ostensen M. Management of early aggressive rheumatoid arthritis during pregnancy and lactation. Expert Opin Pharmacother. 2009 Abstract
  23. Østensen M, Lockshin M, Doria A, Valesini G, Meroni P, Gordon C, Brucato A, Tincani A. Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs. Rheumatology (Oxford). 2008 Abstract Full text (link to original source) Full text (in our servers)
  24. Weber JC, Kuhnert C. Traitements de fond des affections inflammatoires systémiques au cours de l’allaitement. [Breastfeeding and drug management in connective tissue and rheumatic diseases]. Rev Med Interne. 2008 Abstract
  25. Young KA, Parrish LA, Zerbe GO, Rewers M, Deane KD, Michael Holers V, Norris JM. Perinatal and early childhood risk factors associated with rheumatoid factor positivity in a healthy paediatric population. Ann Rheum Dis. 2007 Feb;66(2):179-83. Abstract
  26. Østensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007 Abstract
  27. Jacobsson LT, Jacobsson ME, Askling J, Knowler WC. Perinatal characteristics and risk of rheumatoid arthritis. BMJ. 2003 May 17;326(7398):1068-9. No abstract available. Abstract
  28. Needs CJ, Brooks PM. Antirheumatic medication during lactation. Br J Rheumatol. 1985 Abstract

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