A woman with rheumatoid arthritis whose condition did not improve during pregnancy.

BACKGROUND

A 25-year-old woman with a 3-year history of rheumatoid arthritis presented 6 months before her first planned pregnancy. At the time of presentation, she was being successfully treated with infliximab and methotrexate. During her pregnancy, the patient discontinued infliximab and methotrexate and her arthritis relapsed. She was treated with low-dose prednisone, sulfasalazine, nimesulide, and intra-articular corticosteroid injections. Oligohydramnios developed at gestational week 18.

INVESTIGATIONS: Laboratory testing, ultrasonography of the fetus and of the patient's affected joints.

DIAGNOSIS: Active arthritis during pregnancy and oligohydramnios suspected to be caused by nimesulide.

MANAGEMENT: Low-dose oral prednisone, sulfasalazine, repeated intra-articular corticosteroid injections. Infliximab and methotrexate were restarted immediately after delivery.