AUTOIMMUNE DISEASES

RHEUMATOID ARTHRITIS:
1. Chronic Systemic Disorder Involving Joints Leading To Destruction.
2. Extraarticular Manifestations:Lymphadenopathy,Fatigue,Anaemia,Weight
Loss,ILD,Pericarditis,Vasculitis,Rheumatoid Nodules,Neuropathy,Renal
Disease.Sjogrens,Felty Syndromes.
3. Female Predisposition Due To Effects Of Estrogen On Immune System.
EFFECT OF PREGNANCY ON RHEUMATOID ARTHRITIS:
1. 75% cases improve with pregnancy.
2. 90% have a relapse in the post partum period.
EFFECT OF RA ON PREGNANCY:
1. Don’t Affect Fertility.
2. But Libido And Coital Frequency Is Reduced.
3. Fetal Morbidity And Mortality Is Not Increased.
4. Major Concern Is The Risk Of Drug Adverse Affects.
5. But Luckily The Symptoms Improve And The Drug Dosage Is Reduced In
Pregnancy.
ANAESTHESIA IMPLICATIONS OF RA:
COMMON DRUGS & TERATOGENICITY:
DRUG TERATOGENICITY
Aspirin PDA Closure.
Glucocorticoids Cleft
lip/palate.preeclampsia,GDM,PROM,IUGR
HCQ`S Fetal ocular/ototoxicity
Azathioprine IUGR?

OBSTETRIC MANAGEMENT:
1. Multidisciplinary Team Approach.
2. Hormones Cause Joint Relaxation Increasing Strain.
3. Uterus Exacerbates Lumbar Lardosis & Thoracic Kyphosis.Vaginal Delivery
Is Preferred.
4. Disease Mechanism Affects The Progression Of Labor.
5. Joint Disease Precludes The Usage Of Stirrups.
6. Additional Doses Of Steroids For Patients On Steroids.

ANAESTHESIA MANAGEMENT:
1. Problems with airway ,positioning ,neuropathy.
2. Sjogrens-corneal inuries,trauma to mucosa.
3. Regiona anaesthesia-not contraindicated,paramedian approach is safer.