65 - Pregnancy and Rheumatic Diseases

Abstract

The rheumatic disorders reviewed in this chapter are characterized by tissue damage resulting from self-reactivity mediated by abnormal immunologic activation. The underlying pathophysiology involves a failure of the complex regulatory mechanisms of the immune system that enable distinguishing “self” from “nonself.” Many rheumatic diseases occur predominantly in women of reproductive age. The immunological and hormonal alterations of gestation may influence rheumatic disease activity; in turn, increased disease activity may be associated with poorer pregnancy outcomes. Moreover, some autoimmune conditions clearly predispose to adverse pregnancy outcomes such as fetal death or poor placental vascularization leading to preeclampsia or placental insufficiency. Treatment of rheumatic disease in pregnancy poses yet another challenge and requires well-coordinated, interdisciplinary care. In this chapter, we summarize the implications and management of systemic lupus erythematosus, antiphospholipid syndrome, rheumatoid arthritis, Sjögren syndrome, systemic sclerosis, and systemic vasculitis in pregnancy. We also profile the potential risks and benefits in pregnancy of the most commonly used antirheumatic drugs.