Pregnancy and rheumatic disease. A review of recent studies in rheumatoid arthritis and ankylosing spondylitis

Abstract

The present paper reviews the results of recent investigations into the influence of pregnancy and sex hormones on rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Prospective patient studies have shown that pregnancy exerts a beneficial effect on the majority of RA patients, while AS patients generally have unchanged disease activity during gestation. In AS, gestational remission was confined to patients with accompanying diseases. A postpartum disease flare-up occurred commonly in both RA and AS. Blood parameters reflected mainly the biochemical changes of normal pregnancy. A decrease of circulating immune complexes has been found in RA patients remitting during pregnancy. No single serum factor or combination of serum factors responsible for gestational remission could be detected. The possible influence of alpha 2-pregnancy-associated globulin on disease activity in pregnant patients remains contradictory. Hormonal contraceptives have been found to be protective against the manifestation of RA in four of five studies. However, no beneficial effect of sex hormones on the symptoms of established RA and AS could be demonstrated.