Medicamentous and non-medicamentous treatment of hip osteoarthritis in pregnant women

The management of pregnant women with severe pain caused by primary or secondary osteoarthritis (OA) of the hip joint (HJ) has not been developed. The aim of the article was to evaluate the influence of NSAIDs, glucocorticoids (GC), analgesics and non-drug treatment methods on pregnancy outcomes in patients with primary and secondary OA HJ.

Methods. The study included 99 pregnant women aged 35 to 49 with an intensive pain (≥4.0 points according to visual analog scale (VAS)) due to primary or secondary OA HJ. Depending on the form of OA, the severity of pain and the patient’s opinion, the following therapy was adminestered: ibuprofen up to 800 mg per day orally (n = 31) or paracetamol up to 1000 mg per day orally (n = 20) or methylprednisolone up to 12 mg per day orally (n = 27) or non-medicamentous methods (n = 21), including educational programs, systematic physical therapy, body mass index correction, instep support, orthosis, etc.). The efficacy of the treatment was evaluated within a month from the beginning of the therapy, pregnancy outcomes for the mother and the fetus and pathology of the child after 12 months after the birth. The factors, associated with low efficacy of treatment, were evaluated.

Results. In 50 (51%) women primary OA HJ was diagnosed, in 49 (49%) — secondary OA HJ. A decrease of pain in HJ in patients of all treatment groups (p > 0.05 for comparison with baseline) was observed. The patients with secondary OA who receiving Methylprednisolone showed a statistically significant (p < 0.05) pain relief compared to the patients in other clinical groups. A correlation was found between the intensity of pain syndrome (VAS) and BMI. 85 (85%) patients had urgent deliveries, 14 (14%) had premature, natural delivery in 82 (82%) women, and a caesarean section was performed in 29 (29%) cases. The cases of ante- and perinatal fetal death were not recorded. Pathological conditions were absent in 28 (84.85%) of newborns, whose mothers refused medical treatment, in 28 (90.32%) newborns, who received ibuprofen, in 15 (75%) — paracetamol, and in 23 (85.19%), who were on methylprednisolone therapy (differences between the goups are unreliable, p ≥ 0.05). In 12 months after birth in the group of newborns receiving antenatal ibuprofen, pathological conditions were observed in 3 children, paracetamol — in 5, metiprednisolone — in 4 children and in 5 children in the group not receiving medicamentous therapy.

Conclusions. 1) The use of non-medicamentous and medicamentous (non-selective NSAIDs or GC in small doses or analgesics) treatment in pregnant women with hip osteoarthritis has equal efficiency and safety for the health of both the mother and the fetus; 2) сhildren born to mothers with primary or secondary hip osteoarthritis treated with NSAIDs or analgesics or GC in age of 12^th month do not differ from children born to mothers with osteoarthritis of hip joints receiving non-medicamentous therapy; 3) an increase of the body mass index of a pregnant woman with osteoarthritis of the hip joints is a predictor of refractoriness to any form of drug and non-drug therapy.