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Comentário
Doença autoimune na qual próprio sistema imunitário ataca por erro a células e tecidos, podendo danificar sobretudo articulações, mas também coração, pele, olhos, pulmões e artérias e veias. É mais frequente em mulheres que em homens. Doença costuma cursar em forma de surtos com períodos intermediários sem sintomas. Tabagismo é fator desencadeante importante. Cerca da metade de mulheres com artrite reumatoide ativa melhoram com gravidez e maioria voltam a ter recidiva nos primeiros meses do pós-parto dificultando-lhes cuidado de seu bebê e amamentação (Bermas 2017, de Jong 2017, Krause 2016, Østensen 2007). Alguns estudos encontraram maior risco de recidivas com amamentação, especialmente em primeiro embaraço (Vieira 2019). Foram encontrados níveis elevados de prolactina em enfermos de artrite reumatoide (Wu 2019). Foi encontrado menor risco de artrite posterior em mulheres que amamentaram (Orellana 2017, Chen 2015). Ter sido amamentado diminui risco de padecer artrite reumatoide (Colebatch 2011, Young 2007, Jacobsson 2003). Autores especialistas e sociedades médicas de Reumatologia consultadas não contraindicam amamentação senão que advogam por escolher cuidadosamente os fármacos anti-inflamatórios e imunossupressores (Paizis 2019, Anderson 2019, Bermas 2017, de Jong 2017, Krause 2016, Ngian 2016, Götestam-EULAR 2016, Flint 2016, Kavanaugh 2015, Sammaritano 2014, Makol 2011, Weber 2008, Østensen 2009, 2008 e 2007, Needs 1985). Ibuprofeno, paracetamol, hidroxicloroquina, corticosteroides, ciclosporina, sulfassalazina e metotrexato a doses de até 25 mg semanais são seguros (Thorne 2014). Entre anticorpos monoclonais contra fator de necrose tumoral (antiTNF) adalimumab, certolizumab e infliximab são seguros durante amamentação por não excretarem-se no leite materno. Não há dados até data para considerar seguros inibidores da quinase Janus como baricitinib e tofacitinib (Anderson 2018 e 2016, de Jong 2017).
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Bibliografia
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