The positive effect of pregnancy in rheumatoid arthritis and the use of medications for the management of rheumatoid arthritis during pregnancy

Sharma, Uday; Rathnakaran, Akhila Nediyedath; Raj, Bharath; Padinjakkara, Gayathry; Das, Akanksh; Vada, Surendra; Mudagal, Manjunatha P.

doi:10.1007/s10787-021-00808-9

Cited by 9 publications

(4 citation statements)

References 116 publications

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“…There was a significant difference between the two subgroups regarding steroid intake during pregnancy, showing that this therapy improved the chance of having a pregnancy without adverse outcomes. Recent studies have demonstrated that oral GCs have no teratogenic effect when used for pregnant patients [ 41 ], but a correlation was made with IUGR and prematurity, with the risk increasing with higher GC dosages [ 34 , 42 , 43 ]. Nonetheless, in our study, the patients were treated with lower or equal to 10 mg of oral prednisone daily, and there was no significant correlation between GC usage and neonates with low birth weight.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Prospectively Followed Pregnancies in Rheumatoid Arthritis: A Multicenter Study from Romania

Bobircă

Simionescu

Mușetescu

et al. 2023

Life

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Women with rheumatoid arthritis (RA) may carry an increased risk of adverse pregnancy outcomes (APO). The aims of this study were to compare pregnancy outcomes in RA patients as compared to the general obstetric population (GOP) and to identify a risk profile in RA. A case-control study was conducted on 82 prospectively followed pregnancies in RA and 299 pregnancies from the GOP. The mean age at conception was 31.50 ± 4.5 years, with a mean disease duration of 8.96 ± 6.3 years. The frequency of APO in RA patients was 41.5%, 18.3% experienced spontaneous abortions, 11.0% underwent preterm deliveries, 7.3% had small for gestational age infants, 4.9% experienced intrauterine growth restriction, 1.2% experienced stillbirth, and 1.2% suffered from eclampsia. The risk of APO was correlated with a maternal age higher than 35 years (p = 0.028, OR = 5.59). The rate of planned pregnancies was 76.8%, and the subfertility rate was 4.9%. Disease activity improved every trimester, and approximately 20% experienced an improvement in the second trimester. Planned pregnancies and corticosteroids use (≤10 mg daily) were protective factors for APO in RA pregnancies (p < 0.001, OR = 0.12, p = 0.016, OR = 0.19, respectively). There was no significant association between APO and disease activity or DMARDs used before and during pregnancy. Regarding the comparison between the RA group and the controls, RA mothers were significantly older (p = 0.001), had shorter pregnancies (p < 0.001), and had neonates with a lower birth weight (p < 0.001).

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Section: Discussionmentioning

confidence: 99%

Outcomes of Prospectively Followed Pregnancies in Rheumatoid Arthritis: A Multicenter Study from Romania

Bobircă

Simionescu

Mușetescu

et al. 2023

Life

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“…Their findings showed that RA-affected women who reach menopause at a young age are more likely to develop comorbidities and have less favorable functional outcomes. 42 Engdahlet al, (2018) reported a potential explanation for the increased prevalence of RA in postmenopausal women by studying the estrogen-based molecular mechanism. They suggested that estrogen (E2) regulated IgG-Fc sialylation by inducing S6gal-1 expression.…”

Section: Ra Pathophysiologymentioning

confidence: 99%

Menopausal Transition and the Development of Rheumatoid Arthritis An Overview

Ramachandran,

Sharma,

Haripriya

et al. 2023

Def. Life. Sc. Jl.

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Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory illness caused by an accumulation of inflammatory infiltration in the synovial membrane, which leads to the progressive deterioration of joint architecture. Women are three times more likely than men to have RA, with more severe functional loss and disability. The purpose of this review is to study the shifts in the hormonal system brought on by menopause and their potential links with RA. Females are more likely to develop RA as a result of hereditary and environmental interactions of sex hormones and their effects on the immune system. Rapid declines in ovarian function and systemic estrogen have been linked to postmenopausal increases in proinflammatory cytokines such as IL-6, TNF-α, and IL-1β. The majority of the data from the literature review imply that female hormone characteristics that can be influenced by hereditary and environmental variables impact the development of autoimmune illnesses, including RA.

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“…In females, inflammatory responses may be altered after menopause, possibly via the effects of loss of estrogen on macrophage functioning [ 38 , 39 ]. Inflammatory responses in females can be altered during pregnancy as discussed in [ 57 , 58 ]. Therefore, females may generally regulate inflammatory processes differently than males.…”

Section: Factors That Can Complicate Post-injury Processes and Inflam...mentioning

confidence: 99%

Creating an Optimal In Vivo Environment to Enhance Outcomes Using Cell Therapy to Repair/Regenerate Injured Tissues of the Musculoskeletal System

Hart

Nakamura

2022

Biomedicines

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Following most injuries to a musculoskeletal tissue which function in unique mechanical environments, an inflammatory response occurs to facilitate endogenous repair. This is a process that usually yields functionally inferior scar tissue. In the case of such injuries occurring in adults, the injury environment no longer expresses the anabolic processes that contributed to growth and maturation. An injury can also contribute to the development of a degenerative process, such as osteoarthritis. Over the past several years, researchers have attempted to use cellular therapies to enhance the repair and regeneration of injured tissues, including Platelet-rich Plasma and mesenchymal stem/medicinal signaling cells (MSC) from a variety of tissue sources, either as free MSC or incorporated into tissue engineered constructs, to facilitate regeneration of such damaged tissues. The use of free MSC can sometimes affect pain symptoms associated with conditions such as OA, but regeneration of damaged tissues has been challenging, particularly as some of these tissues have very complex structures. Therefore, implanting MSC or engineered constructs into an inflammatory environment in an adult may compromise the potential of the cells to facilitate regeneration, and neutralizing the inflammatory environment and enhancing the anabolic environment may be required for MSC-based interventions to fulfill their potential. Thus, success may depend on first eliminating negative influences (e.g., inflammation) in an environment, and secondly, implanting optimally cultured MSC or tissue engineered constructs into an anabolic environment to achieve the best outcomes. Furthermore, such interventions should be considered early rather than later on in a disease process, at a time when sufficient endogenous cells remain to serve as a template for repair and regeneration. This review discusses how the interface between inflammation and cell-based regeneration of damaged tissues may be at odds, and outlines approaches to improve outcomes. In addition, other variables that could contribute to the success of cell therapies are discussed. Thus, there may be a need to adopt a Precision Medicine approach to optimize tissue repair and regeneration following injury to these important tissues.

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The positive effect of pregnancy in rheumatoid arthritis and the use of medications for the management of rheumatoid arthritis during pregnancy

Cited by 9 publications

References 116 publications

Outcomes of Prospectively Followed Pregnancies in Rheumatoid Arthritis: A Multicenter Study from Romania

Outcomes of Prospectively Followed Pregnancies in Rheumatoid Arthritis: A Multicenter Study from Romania

Menopausal Transition and the Development of Rheumatoid Arthritis An Overview

Creating an Optimal In Vivo Environment to Enhance Outcomes Using Cell Therapy to Repair/Regenerate Injured Tissues of the Musculoskeletal System

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