In managing rheumatoid lung disease, the following key points should be kept in mind:With rheumatoid pleural effusions, glucose levels in the pleural fluid are low because of a glucose transporter defectPulmonary hypertension in RA is rareInfection—in particular, mycobacterial disease—must be ruled out in RA patients who have been treated with TNF inhibitors and other biologic agentsHerbert S Diamond, MD, MACP; Mythili Seetharaman, MD | October 21, 2022 |. Methotrexate is a folate antagonist.
are classified as category X agents and thus should not be administered to pregnant women. TNF inhibitors and calcineurin inhibitors may be continued during pregnancy. Abatacept, rituximab, and mycophenolate must be withdrawn before pregnancy. Usually, RA improves during pregnancy and flares after delivery.
After leflunomide is discontinued and supportive care initiated, the next step in management is to administer cholestyramine. Because of the long half-life and enterohepatic circulation of leflunomide, discontinuance alone does not clear the drug rapidly enough, and a bile acid resin such as cholestyramine must be administered to speed clearance.