Monoarticular rheumatoid arthritis in pregnancy: A case report

Abstract

Rheumatoid arthritis (RA) is a lifelong, systemic autoimmune disease that affects women three times more frequently than men, often in their most productive and childbearing years. This chronic inflammatory disease occurs mainly due to immunological dysfunction and infiltration of T cells secreting cytokines causing inflammation and arthritis due to cartilage destruction and systemic symptoms. The primary feature being inflammatory synovitis which usually involves the peripheral joints. The mainstay of management of rheumatoid arthritis includes Disease Modifying Antirheumatic Drugs (DMARDs), most of which are contraindicated in pregnancy, thus causing a significant complexity in management during pregnancy. In our case, A 28 year old female, Primigravida with 26 weeks of gestation came to the OPD of department of Obstetrics and Gynaecology, MGM hospital with complaints of pain in the left knee joint for the past one year, aggravated two weeks back and diffuse swelling over the joint since 1 month. A diagnosis of monoarticular Rheumatoid arthritis was formed after ruling out other pathologies like reactive arthritis, tuberculosis of knee joint, referred pain due to pathologies in the neighbouring joints. Since the patient was pregnant, a decision based on level five evidence, was taken to avoid the DMARDs due to their potential teratogenicity and she was managed with an intra-articular injection of corticosteroid which showed no improvement in the patient's symptoms. Hence it was followed by an intra-articular injection of 8ml of Platelet rich plasma (PRP) which resulted in an improvement in VAS scores from 8 to 2, 4weeks after injection along with a clinical reduction in joint swelling and pain even at extremes of movements. The clinical benefits of PRP in RA can possibly be explained by its antiinflammatory effects.

Content, Structure and Delivery Characteristics of Yoga Interventions for Managing Rheumatoid Arthritis: A Systematic Review Protocol

“…There is no cure for rheumatoid arthritis, but the disease can be managed using pharmacological and non-pharmacological interventions [3]. The main aim is early diagnosis and treatment to prevent irreversible damage to the joints by lowering disease activity, reducing pain and inflammation and improving function [3,16]. Pharmacological interventions include the use of disease-modifying anti-rheumatic drugs (DMARDs) that are administered orally, subcutaneously or intravenously to suppress autoimmune activity and delay or prevent joint degeneration [16,17].…”

“…The main aim is early diagnosis and treatment to prevent irreversible damage to the joints by lowering disease activity, reducing pain and inflammation and improving function [3,16]. Pharmacological interventions include the use of disease-modifying anti-rheumatic drugs (DMARDs) that are administered orally, subcutaneously or intravenously to suppress autoimmune activity and delay or prevent joint degeneration [16,17]. Conventional synthetic DMARDs (cs-DMARDs) such as methotrexate are used as first-line therapy due to their effectiveness and safety, flexible administration and low cost [17].…”

“…These are highly specific in their mechanism of action and can have serious adverse effects such as increased risk of opportunistic and bacterial infections and reactivation of tuberculosis [19]. Other pharmacological interventions include Janus kinase (JAK) inhibitors for people with severe disease and non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen) to reduce pain by decreasing inflammation but can have side effects such as gastrointestinal ulceration, renal failure and heart failure [3,16]. Glucocorticoids (e.g., dexamethasone) are more effective but less safe than NSAIDs due to long-term side effects such as weight gain, muscle weakness and bone thinning [20].…”

“…Glucocorticoids (e.g., dexamethasone) are more effective but less safe than NSAIDs due to long-term side effects such as weight gain, muscle weakness and bone thinning [20]. In short, the medications used to treat rheumatoid arthritis can have strong side effects and are often not well-tolerated and ultimately can lead to high treatment costs [16]. Along with pharmacological interventions, non-pharmacological interventions such as brisk walking and moderate-to-high intensity exercise are recommended to improve or maintain mobility and joint function [1,21].…”