Impact of pregnancy on rheumatoid arthritis activity

摘要

Evaluation of: de Man YA, Dolhain RJ, van de Geijn FE, Willemsen SP, Hazes JM: Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Rheum. 59(9), 1241–1248 (2008). For many women with rheumatoid arthritis (RA), pregnancy is remembered as a time of relative comfort and well-being, with arthritis frequently entering remission. Since the 1930s, it has been recognized that RA abates during pregnancy and flares after delivery. In this study, almost half of women with RA had a moderate improvement of symptoms during pregnancy, and 40% worsened following delivery, a more modest change in disease activity than that observed in prior studies. Medication changes surrounding pregnancy were dramatic, with two-thirds of women discontinuing DMARD therapy during pregnancy, and 90% returning to it following delivery. Pregnancy creates in the mother an immunologically unique environment in which tolerance to a semi-allogeneic transplant (the fetus) develops. This altered immunological state in turn may promote maternal tolerance to self and amelioration of RA activity. Improved understanding of these immune changes during pregnancy may lead to the discovery of novel therapies for RA in the future.