Rheumatic Diseases and Their Treatment with Anti-Rheumatic Drugs during Pregnancy

Pinar Borman, Oya Ozdemir
2015 Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi  
Özet Otoimmün romatizmal hastal›klar s›kl›kla üreme ça¤›ndaki bireyleri etkiler. Plans›z gebelik durumunda kullan›lan ilaçlar ve/veya aktif romatizmal has-tal›k obstetrik komplikasyon riskini art›rabilmektedir. Gebelik seyrinde ilaç kullan›m› ile ilgili bilgilerimiz ço¤u ilaç için oldukça s›n›rl› ve genellikle plan-s›z gebelikler s›ras›nda oluflan ilaç maruziyetleri sonucu y›llar içinde biriken bilgilerdir. Gebelik sürecinde ilaç tedavilerinin do¤ru yönetimi için European League Against
more » ... gue Against Rheumatology (EULAR) ve British Society of Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) gibi derneklerin, gebelikte romatizmal ilaç kullan›m önerileri güncellenerek yay›nlamaktad›r. Türkiye Romatoloji Derne¤i (TRD) olarak, romatizmal hastal›klarda gebelik ve laktasyon dönemlerinde anti-romatizmal ilaçlar›n yönetimine yönelik ulusal tedavi önerileri oluflturulmas› kararlaflt›r›lm›flt›r. Burada amaç, romatizmal hastal›klarda; gebelik plan›, konsepsiyon, gebelik ve laktasyon, dönemlerinde anti-romatizmal ilaçlar›n kullan›m› ve afl›lama gibi önemli konularda yol gösterici "öneriler" oluflturmak fleklinde belirlenmifltir. Bu öneriler; romatoloji, pediatri ile kad›n hastal›klar› ve do¤um hekimlerinden oluflan multidisipliner bir çal›flma grubu taraf›ndan oluflturulmufltur. Öneriler oluflturulurken, EULAR, BSR ve BHPR gibi romatoloji derneklerinin gebelikte romatizmal ilaç kullan›m›na dair güncel önerileri ve referanslar› temel al›nm›flt›r. Çal›flma grubu taraf›ndan, mevcut ulusla-raras› önerilerin ve referanslar›n güncellenmesine yönelik literatür tarama-s› yap›lm›flt›r. Oluflturulan öneriler tasla¤› romatoloji derne¤i üyelerinin de-¤erlendirilmesine sunularak gözden geçirilmifltir. Oluflturulan önerilerin son hali tekrar TRD dernek üyelerine sunularak oylanm›flt›r [puanlama 0-10 (0: Hiç kat›lm›yorum, 10: Kesinlikle kat›l›yorum)]. 7 Nisan 2017 tarihinde ön de¤erlendirme ve planlama, 6 May›s 2017 tarihinde "öneriler tasla¤›" üzerinde uzlafl› ve yaz›m planlamas› olarak; çal›flma grubu üyelerinin kat›l›m›yla 2 defa toplant› yap›lm›flt›r. Haz›rlanan taslak öneriler Eylül 2018'de dernek üyelerine sunularak gözden geçirilmifltir. Nisan 2019'da oluflturulan önerilerin son hali dernek üyelerince oylanm›flt›r. Summary Autoimmune rheumatic diseases are often seen in individuals at reproductive age. Medications used in case of unplanned pregnancy and / or active rheumatic disease may increase the risk of obstetric complications. Knowledge about the medications used during pregnancy is limited and it is usually accumulated over the years as a result of medications exposure during unplanned pregnancies. Recently, European League Against Rheumatology (EULAR) and the British Society of Rheumatology (BSR) and the British Health Professionals in Rheumatology (BHPR) updated and published the guidelines for the management of rheumatic diseases during pregnancy. As Turkish Society for Rheumatology (TRD), we have decided to develop national treatment recommendations for the proper management of anti-rheumatic drugs during pregnancy and lactation in rheumatic diseases. The aim here is to establish guiding "recommendations" on significant matters such as pregnancy plan and the use of antirheumatic drugs during conception, gestation and lactation periods and vaccination. This guideline was created by a multidisciplinary working group consist of rheumatology, obstetrics and pediatrics physicians. These recommendations are based on the current recommendations of rheumatic drug use during pregnancy by the EULAR, BSR and BHPR. A literature review was conducted by the working group to update existing international recommendations and its references. The draft of recommendations was submitted to TRD members for their preliminary evaluation. After the revised recommendations were created, the final version was submitted to TRD members and voted [scoring 0-10 (0: Strongly disagree, 10: Strongly agree)]. Two meetings were held with the participation of the working group, one on April 7, 2017 for the preliminary evaluation and the planning, and the other on May 6, 2017 for consensus and writing planning on "the draft of recommendations". The draft recommendations prepared were reviewed by TRD members on September 2018. The final version of the recommendations were voted by the members on April 2019. Öneri / Recommendation Ulus Romatol Derg 2019;11(2):91-104.
doi:10.5152/tftrd.2015.90688 fatcat:my2jzrngnrd4ploavur7atlwlm