Arthritis in pregnancy: the role and safety of biological agents

As the average age of mothers is increasing there is a greater likelihood that they will have intercurrent medical problems at the time of their pregnancy. As a group, autoimmune diseases are relatively common with an estimated population prevalence of 5-8%. At least 75% of autoimmune diseases occur in women, most frequently during the child-bearing years. Rheumatoid arthritis (RA) is the most common chronic inflammatory disease of joints and occurs in approximately 1% of the population with women being affected two or three times more than men and many of the women being of child-bearing age. The pathogenesis of RA is multifactorial with a role for T-lymphocytes, B-lymphocytes, macrophages and other pro-inflammatory cells producing a plethora of cytokines including interleukin-1 and tumour necrosis factor-α in the synovial cavity resulting in irreversible damage to cartilage, soft tissues and bone.(1) The drug treatment of RA involves the use of disease-modifying agents to reduce or prevent permanent tissue damage. There is a new class of drugs that can be used to target specific cells and cytokines that have been called 'biological agents'. These drugs have been shown to significantly reduce inflammation and to retard the progression of joint damage in RA thereby reducing symptoms and improving function.(2).