Miscarriage but not fecundity is associated with progression of joint destruction in rheumatoid arthritis

Abstract

Objective: To determine whether reproductive history before disease onset is associated with severity of joint destruction in rheumatoid arthritis. Methods: A special early arthritis clinic (EAC) was established at the department of rheumatology of Leiden University Medical Centre. General practitioners were encouraged to refer patients with joint complaints to this clinic, where the diagnosis of rheumatoid arthritis was made by a rheumatologist. In all, 113 female patients with definite rheumatoid arthritis were included in this study. A structured questionnaire was administered and joint damage was assessed by sequential x rays of the hands and feet, using the modified Sharp score. Results: The length of time of unprotected intercourse until first pregnancy (fecundity) was comparable with data from earlier studies, with 16% of the patients reporting a time to first pregnancy of more than 12 months. Fecundity did not reflect the extent of joint damage over time. The miscarriage rate was 15% per pregnancy, comparable to population figures (12-15%). A significant increase in joint damage over a two year follow up was found in patients with rheumatoid arthritis who had experienced at least one miscarriage compared with those who had never had a miscarriage (mean modified Sharp scores at 2 years, 24 (95% confidence interval, 15 to 32) and 16 (10 to 23), respectively; p,0.05). At baseline, the Sharp scores were similar in the two subgroups. Conclusions: Miscarriage before disease onset but not fecundity is associated with the progression of joint damage in rheumatoid arthritis.

National cohort study of reproductive risk factors for rheumatoid arthritis in Denmark: a role for hyperemesis, gestational hypertension and pre-eclampsia?

“…Theoretically, women with one child only might have experienced fertility or pregnancy problems more frequently than women with two or more children. If so, the finding that one-child mothers are at an increased risk of RA is compatible with studies showing increased frequencies of subfertility before the onset of RA 6 12 14 17 21…”

“…During pregnancy, women with already established RA often undergo clinical remission whereas, in the postpartum period, symptoms may exacerbate 4 5. Several studies have investigated possible associations between reproductive factors and the risk of RA 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21. While studies generally agree that abortions and stillbirths are not related to the risk of RA,6 9 13 15 19 results for other pregnancy variables vary considerably 9 10 13 15 17 20…”

Reproductive history and postmenopausal rheumatoid arthritis among women 60 years or older

“…6 Second, maternal-fetal disparity in human leukocyte antigen class II antigens may be important for reducing RA symptoms during pregnancy. 18 Whereas a low T H 1/T H 2 ratio promotes successful pregnancy, a high T H 1/T H 2 ratio (a characteristic of RA-diagnosed women) has the potential to reduce fertility and fecundity and to increase the likelihood of spontaneous abortion. In fact, pregnancy is accompanied by complex variations in hormone levels, cytokine profiles, and immune cell function.…”

“…6 Third, pregnancy can delay the onset of RA symptoms with better prognosis. 18 Parity has been the most widely examined reproductive characteristic in relation to RA development. 7 Estrogen, progesterone, and cortisol levels increase during the course of a pregnancy, favoring cytokine profiles and CD4 + regulatory T-cells that counter cell-mediated autoimmunity, all of which substantially decline in the postpartum period.…”

Schwangerschaft bei rheumatoider Arthritis oder Spondyloarthritiden

“…Möglicher-weise ist eine vorliegende Th1-geprägte Immunantwort in der Abortgruppe ungünstig für den RA-Verlauf. Es bestünde somit ein gleiches genetisches Risiko sowohl für eine Schwangerschaftskomplikation als auch für einen ungünstigen RAVerlauf [53].…”