Pregnancy in Rheumatoid Arthritis, Sjögren Syndrome and Other Rare Autoimmune Rheumatic Diseases

Abstract

Publisher Summary This chapter discusses the relationship between pregnancy and the autoimmune rheumatic diseases (ARD) and presents the guidelines for the management of these conditions during pregnancy. Data on pregnancy outcome of some of these ARD are very limited. ARD affect young females in their childbearing age. Over the past decades, the improvement of survival rate, as well as quality of life in patients affected with ARD, has led to more pregnancies observed during these diseases. Pregnancy is a condition in which profound immune and endocrine changes occur. The physiological increase of cortisol, progesterone, estradiol, and testosterone during the 3rd trimester of pregnancy seems to lead to Th-2 cytokine polarization both at the systemic level and at the feto–maternal interface. It has been suggested that some autoimmune diseases, such as systemic lupus erythematosus (SLE), which are mediated mainly by Th-2 cytokines, tend to occur or relapse during pregnancy, whereas Th-1 mediated diseases, such as rheumatoid arthritis (RA), tend to improve. In either case a flare or onset of disease occur during postpartum, when the anti-inflammatory Th-2 cytokines collapse. SLE is the most frequently observed ARD during pregnancy. However, pregnancy occurs in patients with rheumatoid arthritis (RA), Sjogren Syndrome (SS), and undifferentiated connective tissue diseases (UCTD) and is instead rare in patients with rare ARD—namely systemic sclerosis (SSc), mixed connective tissue diseases (MCTD), polymyositis–dermatomyositis (PM–DM), systemic vasculitis including Wegener's granulomatosis (WG), Churg–Strauss syndrome (CSS), polyarteritis nodosa (PAN), microscopic polyangitis (MPA), Takayasu arteritis (TA), and Behcet disease (BD). The onset of most of these latter diseases occurs in patients after the age of 40.