Pregnancy and rheumatoid arthritis - Rheumatic, obstetric and gynecologic aspects

Initial onset of rheumatoid arthritis (RA) during pregnancy is very rare. Significant improvement of symptoms and signs of RA occurs in most patients in the first trimester and persists throughout the pregnancy. The disease usually flares up a few months after delivery. Various hormonal changes which occur during pregnancy contribute to the observed amelioration. One of these changes is enhanced activity of T helper cells (Th2) and down-regulation of TH1 cells. As a result there is also decreased production of proinflammatory cytokines such as TNF-a and others. In addition, maternal-fetal disparity in the class II antigens HLA-DR and HLA-DQ correlates significantly with the amelioration of RA during pregnancy. Most of the disease-modifying anti-rheumatic drugs are contraindicated or non-recommended during pregnancy and lactation. There is insufficient data about the safety of the new biologic drugs such as anti-TNF-a during pregnancy, although a few recently published studies did not reveal any complications or unexpected side effects on the course of pregnancy and outcome of the newborn. The obstetric and gynecologic complications are rare and negligible.