Monoarticular rheumatoid arthritis in pregnancy: A case report

Abstract

Rheumatoid arthritis (RA) is a lifelong, systemic autoimmune disease that affects women three times more frequently than men, often in their most productive and childbearing years. This chronic inflammatory disease occurs mainly due to immunological dysfunction and infiltration of T cells secreting cytokines causing inflammation and arthritis due to cartilage destruction and systemic symptoms. The primary feature being inflammatory synovitis which usually involves the peripheral joints. The mainstay of management of rheumatoid arthritis includes Disease Modifying Antirheumatic Drugs (DMARDs), most of which are contraindicated in pregnancy, thus causing a significant complexity in management during pregnancy. In our case, A 28 year old female, Primigravida with 26 weeks of gestation came to the OPD of department of Obstetrics and Gynaecology, MGM hospital with complaints of pain in the left knee joint for the past one year, aggravated two weeks back and diffuse swelling over the joint since 1 month. A diagnosis of monoarticular Rheumatoid arthritis was formed after ruling out other pathologies like reactive arthritis, tuberculosis of knee joint, referred pain due to pathologies in the neighbouring joints. Since the patient was pregnant, a decision based on level five evidence, was taken to avoid the DMARDs due to their potential teratogenicity and she was managed with an intra-articular injection of corticosteroid which showed no improvement in the patient’s symptoms. Hence it was followed by an intra-articular injection of 8ml of Platelet rich plasma (PRP) which resulted in an improvement in VAS scores from 8 to 2, 4weeks after injection along with a clinical reduction in joint swelling and pain even at extremes of movements. The clinical benefits of PRP in RA can possibly be explained by its anti-inflammatory effects.