Rheumatoid arthritis and pregnancy

Gary Klipple, F. A. Cecere

Research output: Contribution to journalReview article

52 Citations (Scopus)

Abstract

The intention of this article is to review the course and outcome of rheumatoid arthritis during pregnancy, discuss current concepts concerning the reason behind the changes that occur and in so doing necessarily explore gestational alterations in the maternal immune system, and finally to describe an approach to the management of pregnant women with RA in the antepartum, partum and postpartum period. The activity of RA is significantly altered by pregnancy with approximately 70 per cent of patients experiencing substantial improvement in symptoms, signs and sometimes extra-articular manifestations. This lessening of disease activity occurs in association with an almost complete cessation of medications. However, whether partial or complete this remission is short-lived with more than 90 per cent of women who improved relapsing by 6 to 8 months postpartum. Further, in approximately 30 per cent of RA patients the course remains unchanged or worsens during gestation and indeed the first symptoms of RA may develop during pregnancy or shortly thereafter. Conversely active rheumatoid arthritis seems to little influence the maternal course or fetal outcome of pregnancy. The multiple and complex immunologic alterations of the pregnant state are designed to ensure survival of the fetal allograft in a foreign host. A number of these alterations particularly involving modulation of cell-mediated immunity, immunoglobulin composition, immune complex generation, or the inflammatory response have the potential to interfere with the pathophysiology of RA. In short, although the specific mechanism remains an enigma, the reason for the amelioration of RA during pregnancy is probably and incidental and fortuitous reaction to one or more of these immunomodulatory factors.

Original languageEnglish (US)
Pages (from-to)213-239
Number of pages27
JournalRheumatic Disease Clinics of North America
Volume15
Issue number2
StatePublished - Jan 1 1989
Externally publishedYes

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Rheumatoid Arthritis
Pregnancy
Postpartum Period
Mothers
Pregnancy Outcome
Antigen-Antibody Complex
Cellular Immunity
Signs and Symptoms
Allografts
Immunoglobulins
Pregnant Women
Immune System
Joints

All Science Journal Classification (ASJC) codes

  • Rheumatology

Cite this

Rheumatoid arthritis and pregnancy. / Klipple, Gary; Cecere, F. A.

In: Rheumatic Disease Clinics of North America, Vol. 15, No. 2, 01.01.1989, p. 213-239.

Research output: Contribution to journalReview article

Klipple, Gary ; Cecere, F. A. / Rheumatoid arthritis and pregnancy. In: Rheumatic Disease Clinics of North America. 1989 ; Vol. 15, No. 2. pp. 213-239.
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