[Pregnant patient with rheumatoid arthritis treated with methotrexate and infliximab].

Tumor necrosis factor-alpha inhibitors have become an established therapeutic regimen for patients with rheumatoid arthritis. Regarding their harmful potential they are classified as category B medications. Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. Disease-modifying antirheumatic drugs (DMARDs) are often used in combination with biological therapy and treatment with methotrexate has shown good results. This antimetabolite is classified as a category X drug and its teratogenic effect is well known. The incidence of inflammatory rheumatic diseases is significantly higher in women. There are many reports on pregnant patients treated with biological therapy, oft en in combination with DMARDs. The effects of such a therapy on reproductive health is a theme of debate, with controversial views on the matter. We present a patient with rheumatoid arthritis whose pregnancy was discovered at 31 weeks of gestation. During that period she had been treated with methotrexate and infliximab, with no adverse effects.

[Relationship between vitamin D status and bone mineral density in Croatian postmenopausal women]. / Povezanost statusa vitamina D s mineralnom gustocom kosti u hrvatskih zena u postmenopauzi.

The aim of the study was to investigate correlation of vitamin D status meassured as 25-hydoxyvitamin D (25(OH)D) concentration with bone mineral density (BMD) in Croatian postmenopausal women. This study was based on the sample of 194 adult, postmenopausal women aged 50 years or over from Croatia. Assessment of 25(OH)D concentration and BMD by dual-energy xray absorptiometry (DXA) was performed to all participants. The average age of the participants in this study was 60.6 years. The average menopause duration was 11.4 years. Among the included participants only 13.9% of women complied with diagnostic criteria for osteoporosis. Mean serum concentration of 25(OH)D was 49.1 nmol/L (+/-17.1 SD). The prevalence of severe vitamin D deficiency was significantly higher in participants with osteoporosis compared with participants with normal BMD (<30 nmol/L; 29.6% vs. 9.8%). Correlation between serum 25(OH)D concentration and BMD was significant and positive at the proximal femur (r=0.18; p=0.026), and at the femoral neck (r=0.15; p<0.001). The results of this study indicate significant and positive correlation between serum 25(OH)D concentration and BMD meassured at the proximal femur and at the femoral neck in Croatian postmenopausal women.