一名20多岁的未妊娠妇女患有秋水仙碱不耐受,激素依赖性复发性特发性心包炎在无计划妊娠时,通过阿纳白拉单药治疗可缓解2年.由于数据非常有限和冲突,欧洲风湿病学协会联盟和美国风湿病学会指南在怀孕期间使用anakinra是模棱两可的,强调个性化的方法。阿纳金拉停产了,但一个月后,在妊娠的第二个月,患者出现急性心包炎发作。多学科,以患者为中心的关于感染的竞争风险的讨论,anakinra的产科并发症和胎儿畸形与次优管理的复发性急性心包炎指导患者选择改善症状控制。恢复每天注射anakinra后,胸痛缓解,CRP恢复正常。在妊娠中期,患者在anakinra上有轻度COVID-19感染和链球菌性咽炎.妊娠34周时,患者早产,并自发阴道分娩健康的新生儿。
A nulligravid woman in her mid-20s with colchicine-intolerant, steroid-dependent recurrent idiopathic pericarditis was in remission for 2 years on anakinra monotherapy when she had an unplanned pregnancy. Due to very limited and conflicting data, European Alliance of Associations for Rheumatology and American College of Rheumatology guidelines are equivocal on the use of anakinra in pregnancy, emphasising an individualised approach. Anakinra was discontinued but a month later, in the second month of gestation, the patient had an acute pericarditis flare. A multidisciplinary, patient-centred discussion about the competing risks of infection, obstetric complications and fetal malformations with anakinra versus suboptimally managed recurrent acute pericarditis guided the patient to choosing improved symptom control. Chest pain resolved and CRP normalised after daily anakinra injections were resumed. In the second trimester, the patient had mild COVID-19 infection and streptococcal pharyngitis on anakinra. At 34 weeks gestation, the patient went into preterm labour and had a spontaneous vaginal delivery of a healthy neonate.