Review paper
The safety of pharmacotherapy of rheumatic diseases in gestation and lactation

Rheumatic diseases frequently occur in young people, including women in the reproductive age. The problem of pregnancy is not a rare issue in this group. The decision about maintenance treatment or treatment of a flare of the disease occurring during pregnancy is always burdened with a high risk of maternal and foetal complications.
The most commonly used nonsteroidal anti inflammatory drugs should be used in the lowest therapeutically sufficient dose and they should be stopped 8 weeks before the delivery. Among the glicocorticosteroids, prednisone and prednisolone have the safest profile as they are 90% metabolized in the placenta. Long-term, multicentre, retrospective studies have shown the relative safety of hydroxychloroquine, sulphasalazine and azathioprine, provided that they are used in the recommended doses under strict rheumatological and obstetrical supervision. Methotrexate, cyclophosphamide, mycophenolate mofetil and leflunomide are contraindicated in pregnancy. The reports on the safety of etanercept and infliximab during pregnancy are optimistic, however scanty. The use of cyclosporine should be limited due to increased risk of maternal and foetal complications.
Low doses of nonsteroidal anti inflammatory drugs and prednisone do not exclude breastfeeding. -term, multicentre, retrospective studies have shown the relative safety of hydroxychloroquine, sulphasalazine and azathioprine, provided that they are used in the recommended doses under strict rheumatological and obstetrical supervision. Methotrexate, cyclophosphamide, mycophenolate mofetil and leflunomide are contraindicated in pregnancy. The reports on the safety of etanercept and infliximab during pregnancy are optimistic, however scanty. The use of cyclosporine should be limited due to increased risk of maternal and foetal complications.
Low doses of nonsteroidal anti inflammatory drugs and prednisone do not exclude breastfeeding.