A woman with rheumatoid arthritis whose condition did not improve during pregnancy

Background A 25-year-old woman with a 3-year history of rheumatoid arthritis presented 6 months before her first planned pregnancy. At the time of presentation, she was being successfully treated with infliximab and methotrexate. During her pregnancy, the patient discontinued infliximab and methotrexate and her arthritis relapsed. She was treated with low-dose prednisone, sulfasalazine, nimesulide, and intra-articular corticosteroid injections. Oligohydramnios developed at gestational week 18. Investigations Laboratory testing, ultrasonography of the fetus and of the patient's affected joints. Diagnosis Active arthritis during pregnancy and oligohydramnios suspected to be caused by nimesulide. Management Low-dose oral prednisone, sulfasalazine, repeated intraarticular corticosteroid injections. Infliximab and methotrexate were restarted immediately after delivery.