TY - JOUR T1 - Pregnancy: Data, Outcomes, and Treatment Paradigms in Rheumatology JF - The Journal of Rheumatology JO - J Rheumatol SP - 1357 LP - 1358 DO - 10.3899/jrheum.150566 VL - 42 IS - 8 AU - ARTHUR KAVANAUGH AU - JOHN J. CUSH Y1 - 2015/08/01 UR - http://www.jrheum.org/content/42/8/1357.abstract N2 - “Doctor, I’m pregnant.” Coming from a patient with rheumatoid arthritis (RA), or another systemic inflammatory autoimmune disease, who is taking a handful of medications, these few words reliably quicken the pulse of all rheumatologists. Perhaps the only thing more worrisome is when the patient says “Doctor, I want to become pregnant.” In either instance, the apprehensive rheumatologist has to weigh the patient’s wishes against the uncertainties inherent in drug use or cessation, and the effects of either on both mother and fetus. The physician’s counsel may range from the pure “stop all your rheumatologic medications”; to the positive “wait and the pregnancy will improve your RA”; or the pragmatic “go see a high-risk obstetrician immediately.” Often our meager guidance is “let me know when things don’t go as planned” or “call me when you’re done.” The patient who wishes to become pregnant is in a difficult situation. It involves actual discussion between doctor and patient without a solid plan, in an area with a dearth of clinical data from which reasonable decisions could be made. Traditionally, such clinical discussions tended to be as dissatisfying to doctors as they were to patients.Pregnancy has often been treated as if it were an adverse event. It was considered something that interrupted an otherwise carefully planned treatment course for the patient’s rheumatologic conditions. Currently, the goal is remission, achieved by using the best possible treatment approaches. The goals of therapy may well be incongruous with the plan for a … Address correspondence to Dr. J.J. Cush, Baylor Research Institute, 9900 N. Central Expressway, Suite 550, Dallas, Texas 75231, USA. E-mail: jjcush{at}gmail.com ER -