Question-104

A couple presented for preconceptional councelling.He is taking medicine for RA.What should be your advice?


a.Stop methotrxate and continue hydroxychloroquine
b.stop both
c.stop hydroxychloroquine and continue methotraxte
d.continue both

a

Acceptable contraception for female patients with RA includes condoms, combined oral contraceptives (OCPs), use of the vaginal ring, or an intrauterine device. Studies have shown that oral contraceptives have little to no effect on the outcome of RA.[16] Men may use condoms to prevent conception until proper preconception planning has occurred.

Patients with chronic pain due to RA may use DMARDs and non-steroidal anti-inflammatory (NSAIDS) to decrease pain. The most common DMARDs used to treat RA include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide. f]]Both methotrexate and leflunomide are pregnancy category X, while sulfasalazine and hydroxychloroquine are generally considered safe to use during pregnancy.[18][/u] Patients wanting to conceive should understand that they must discontinue DMARDS at least 3 months (methotrexate) and up to 2 years (leflunomide) prior to conception due to the long tissue half-life of DMARDS that can pose a risk of harm to the fetus.[19,20] Female patients taking DMARDs during pregnancy should only do so after careful consideration of the risks versus benefits. Additionally, the lowest effective dose of prednisone is also considered safe to treat RA symptoms during the second and third trimesters of pregnancy.[20] If medications that affect sperm or egg production are going to be used, it may be advisable to counsel male and female patients on preserving sperm or eggs for future planned pregnancies.

NSAIDS are generally safe until the third trimester and should then be discontinued, while Tylenol is considered to be safe during pregnancy to relieve pain. All women should be counseled not to become pregnant during active RA disease and should optimize their health prior to conception for the best pregnancy outcome.[19]

Patients with RA can successfully conceive children when they have a clear understanding of the risks. With proper preconception counseling and care, patients lessen the risks and prevent complications of RA during pregnancy.

http://www.medscape.com/viewarticle/578245_3
Journal for Nurse Practitioners

a

A

Methotrexate and leflunomide -- can cause birth defects. These same medications may also cause birth defects if they are taken by men who father children.

So the answer is Stop methotrexate and continue the other drug.

a