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Contraception and Pregnancy in Patients with Rheumatic Disease pp 139–158Cite as

Rheumatoid Arthritis and Seronegative Spondyloarthropathy

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Abstract

Rheumatic diseases influence reproductive function and pregnancy. At the same time pregnancy often has an effect on the signs and symptoms of rheumatic disease as well as on pregnancy outcome. Rheumatoid arthritis (RA) and spondyloarthropathies (SpA), the latter including psoriatic arthritis and ankylosing spondylitis (AS), share features like joint inflammation and damage, but are different in regard to autoimmune features. Fertility is reduced in both RA and SpA after disease onset. RA improves spontaneously in most patients during pregnancy, whereas activity of AS is not profoundly altered during pregnancy. A relapse of arthritis within 6 months after pregnancy occurs in 60–90 % of patients with RA and AS. Pregnancy loss is slightly increased in RA, but not in SpA. Conception at an active stage of disease increases the risk of adverse maternal and fetal outcomes. Women with RA and SpA have an increased risk for premature birth, cesarean section, low birth weight and small for gestational age infants. Careful monitoring throughout pregnancy and interdisciplinary care and management is necessary for patients with rheumatic disease who are pregnant. Pre-pregnancy assessment and counseling is warranted for all patients who desire children.

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References

  1. Klareskog L, Padyukov L, Ronnelid J, Alfredsson L. Genes, environment and immunity in the development of rheumatoid arthritis. Curr Opin Immunol. 2006;18:650–5.

    Article  PubMed  CAS  Google Scholar 

  2. Brewerton DA, Hart FD, Nicholls A, Caffrey M, James DC, Sturrock RD. Ankylosing spondylitis and HL-A 27. Lancet. 1973;1:904–7.

    Article  PubMed  CAS  Google Scholar 

  3. Schlosstein L, Terasaki PI, Bluestone R, Pearson CM. High association of an HL-A antigen, W27, with ankylosing spondylitis. N Engl J Med. 1973;288:704–6.

    Article  PubMed  CAS  Google Scholar 

  4. Lories RJ, Baeten DL. Differences in pathophysiology between rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27:S10–4.

    PubMed  CAS  Google Scholar 

  5. Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KA, Nordvag BY, Koldingsnes W, et al. Fertility in women with chronic inflammatory arthritides. Rheumatology (Oxford). 2011;50: 1162–7.

    Article  Google Scholar 

  6. Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KA, Nordvag BY, Koldingsnes W, et al. Parity in patients with chronic inflammatory arthritides childless at time of diagnosis. Scand J Rheumatol. 2012;41:202–7.

    Article  PubMed  CAS  Google Scholar 

  7. Katz PP. Childbearing decisions and family size among women with rheumatoid arthritis. Arthritis Rheum. 2006;55:217–23.

    Article  PubMed  Google Scholar 

  8. Clowse ME, Chakravarty E, Costenbader KH, Chambers C, Michaud K. Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2012;64:668–74.

    Article  Google Scholar 

  9. Skomsvoll JF, Ostensen M, Baste V, Irgens LM. Number of births, interpregnancy interval, and subsequent pregnancy rate after a diagnosis of inflammatory rheumatic disease in Norwegian women. J Rheumatol. 2001;28:2310–4.

    PubMed  CAS  Google Scholar 

  10. Chakravarty EF, Nelson L, Krishnan E. Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum. 2006;54:899–907.

    Article  PubMed  Google Scholar 

  11. Lin HC, Chen SF, Lin HC, Chen YH. Increased risk of adverse pregnancy outcomes in women with rheumatoid arthritis: a nationwide population-based study. Ann Rheum Dis. 2010;69:715–7.

    Article  PubMed  Google Scholar 

  12. Reed SD, Vollan TA, Svec MA. Pregnancy outcomes in women with rheumatoid arthritis in Washington State. Matern Child Health J. 2006;10:361–6.

    Article  PubMed  Google Scholar 

  13. Skomsvoll JF, Ostensen M, Irgens LM, Baste V. Pregnancy complications and delivery practice in women with connective tissue disease and inflammatory rheumatic disease in Norway. Acta Obstet Gynecol Scand. 2000;79:490–5.

    Article  PubMed  CAS  Google Scholar 

  14. Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KA, Nordvag BY, Koldingsnes W, et al. Pregnancy and delivery in women with chronic inflammatory arthritides with a specific focus on first birth. Arthritis Rheum. 2011;63:1534–42.

    Article  PubMed  Google Scholar 

  15. Tollanes MC, Melve KK, Irgens LM, Skjaerven R. Reduced fertility after cesarean delivery: a maternal choice. Obstet Gynecol. 2007;110:1256–63.

    Article  PubMed  Google Scholar 

  16. Pope JE, Bellamy N, Stevens A. The lack of associations between rheumatoid arthritis and both nulliparity and infertility. Semin Arthritis Rheum. 1999;28:342–50.

    Article  PubMed  CAS  Google Scholar 

  17. Skomsvoll JF, Ostensen M, Schei B. Reproduction in women reporting chronic musculoskeletal disorders. Scand J Rheumatol. 2000;29:103–7.

    Article  PubMed  CAS  Google Scholar 

  18. van Zeben D, Hazes JM, Vandenbroucke JP, Dijkmans BA, Cats A. Diminished incidence of severe rheumatoid arthritis associated with oral contraceptive use. Arthritis Rheum. 1990;33:1462–5.

    Article  PubMed  Google Scholar 

  19. Camacho EM, Lunt M, Farragher TM, Verstappen SM, Bunn DK, Symmons DP. The relationship between oral contraceptive use and functional outcome in women with recent-onset inflammatory polyarthritis: results from the Norfolk Arthritis Register. Arthritis Rheum. 2011;63:2183–91.

    Article  PubMed  CAS  Google Scholar 

  20. Cassina M, Johnson DL, Robinson LK, Braddock SR, Xu R, Jimenez JL, et al. Pregnancy outcome in women exposed to leflunomide before or during pregnancy. Arthritis Rheum. 2012;64:2085–94.

    Article  PubMed  CAS  Google Scholar 

  21. Chambers CD, Johnson DL, Robinson LK, Braddock SR, Xu R, Lopez-Jimenez J, et al. Birth outcomes in women who have taken leflunomide during pregnancy. Arthritis Rheum. 2010;62:1494–503.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ostensen M, von EM, Villiger PM. Therapy with immunosuppressive drugs and biological agents and use of contraception in patients with rheumatic disease. J Rheumatol. 2007;34: 1266–9.

    PubMed  Google Scholar 

  23. McHugh NJ, Reilly PA, McHugh LA. Pregnancy outcome and autoantibodies in connective tissue disease. J Rheumatol. 1989;16:42–6.

    PubMed  CAS  Google Scholar 

  24. Siamopoulou-Mavridou A, Manoussakis MN, Mavridis AK, Moutsopoulos HM. Outcome of pregnancy in patients with autoimmune rheumatic disease before the disease onset. Ann Rheum Dis. 1988;47:982–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  25. Silman AJ, Roman E, Beral V, Brown A. Adverse reproductive outcomes in women who subsequently develop rheumatoid arthritis. Ann Rheum Dis. 1988;47:979–81.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  26. Spector TD, Silman AJ. Is poor pregnancy outcome a risk factor in rheumatoid arthritis? Ann Rheum Dis. 1990;49:12–4.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Norgaard M, Larsson H, Pedersen L, Granath F, Askling J, Kieler H, et al. Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Intern Med. 2010;268:329–37.

    Article  PubMed  CAS  Google Scholar 

  28. Skomsvoll JF, Ostensen M, Irgens LM, Baste V. Perinatal outcome in pregnancies of women with connective tissue disease and inflammatory rheumatic disease in Norway. Scand J Rheumatol. 1999;28:352–6.

    Article  PubMed  CAS  Google Scholar 

  29. Barnabe C, Faris PD, Quan H. Canadian pregnancy outcomes in rheumatoid arthritis and systemic lupus erythematosus. Int J Rheumatol. 2011;2011:345727.

    Article  PubMed  PubMed Central  Google Scholar 

  30. de Man YA, Hazes JM, van der HH, Willemsen SP, de Groot CJ, Steegers EA, et al. Association of higher rheumatoid arthritis disease activity during pregnancy with lower birth weight: results of a national prospective study. Arthritis Rheum. 2009;60:3196–206.

    Article  PubMed  Google Scholar 

  31. Ostensen M, Husby G. A prospective clinical study of the effect of pregnancy on rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum. 1983;26:1155–9.

    Article  PubMed  CAS  Google Scholar 

  32. Ostensen M, Fuhrer L, Mathieu R, Seitz M, Villiger PM. A prospective study of pregnant patients with rheumatoid arthritis and ankylosing spondylitis using validated clinical instruments. Ann Rheum Dis. 2004;63:1212–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  33. Torry DS, Hinrichs M, Torry RJ. Determinants of placental vascularity. Am J Reprod Immunol. 2004;51:257–68.

    Article  PubMed  Google Scholar 

  34. Wong M, Toh L, Wilson A, Rowley K, Karschimkus C, Prior D, et al. Reduced arterial elasticity in rheumatoid arthritis and the relationship to vascular disease risk factors and inflammation. Arthritis Rheum. 2003;48:81–9.

    Article  PubMed  Google Scholar 

  35. Bowden AP, Barrett JH, Fallow W, Silman AJ. Women with inflammatory polyarthritis have babies of lower birth weight. J Rheumatol. 2001;28:355–9.

    PubMed  CAS  Google Scholar 

  36. Nelson JL, Ostensen M. Pregnancy and rheumatoid arthritis. Rheum Dis Clin North Am. 1997;23:195–212.

    Article  PubMed  CAS  Google Scholar 

  37. Forger F, Ostensen M, Schumacher A, Villiger PM. Impact of pregnancy on health related quality of life evaluated prospectively in pregnant women with rheumatic diseases by the SF-36 health survey. Ann Rheum Dis. 2005;64:1494–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  38. Barrett JH, Brennan P, Fiddler M, Silman AJ. Does rheumatoid arthritis remit during pregnancy and relapse postpartum? Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy. Arthritis Rheum. 1999;42:1219–27.

    Article  PubMed  CAS  Google Scholar 

  39. 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. 2008;59:1241–8.

    Article  PubMed  Google Scholar 

  40. Forger F, Vallbracht I, Helmke K, Villiger PM, Ostensen M. Pregnancy mediated improvement of rheumatoid arthritis. Swiss Med Wkly. 2012;142:w13644.

    PubMed  Google Scholar 

  41. de Man YA, Bakker-Jonges LE, Goorbergh CM, Tillemans SP, Hooijkaas H, Hazes JM, et al. Women with rheumatoid arthritis negative for anti-cyclic citrullinated peptide and rheumatoid factor are more likely to improve during pregnancy, whereas in autoantibody-positive women autoantibody levels are not influenced by pregnancy. Ann Rheum Dis. 2010;69:420–3.

    Article  PubMed  Google Scholar 

  42. Camacho EM, Farragher TM, Lunt M, Verstappen SM, Bunn D, Symmons DP. The relationship between post-onset pregnancy and functional outcome in women with recent onset inflammatory polyarthritis: results from the Norfolk Arthritis Register. Ann Rheum Dis. 2010;69:1834–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Barrett JH, Brennan P, Fiddler M, Silman A. Breast-feeding and postpartum relapse in women with rheumatoid and inflammatory arthritis. Arthritis Rheum. 2000;43:1010–5.

    Article  PubMed  CAS  Google Scholar 

  44. Drossaers-Bakker KW, Zwinderman AH, Van ZD, Breedveld FC, Hazes JM. Pregnancy and oral contraceptive use do not significantly influence outcome in long term rheumatoid arthritis. Ann Rheum Dis. 2002;61:405–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  45. Ostensen M, Villiger PM. The remission of rheumatoid arthritis during pregnancy. Semin Immunopathol. 2007;29:185–91.

    Article  PubMed  Google Scholar 

  46. Ostensen M, Villiger PM, Forger F. Interaction of pregnancy and autoimmune rheumatic disease. Autoimmun Rev. 2012;11:A437–46.

    Article  PubMed  CAS  Google Scholar 

  47. van de Geijn FE, Wuhrer M, Selman MH, Willemsen SP, de Man YA, Deelder AM, et al. Immunoglobulin G galactosylation and sialylation are associated with pregnancy-induced improvement of rheumatoid arthritis and the postpartum flare: results from a large prospective cohort study. Arthritis Res Ther. 2009;11:R193.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kuroki K, Hirose K, Okabe Y, Fukunaga Y, Takahashi A, Shiroishi M, et al. The long-term immunosuppressive effects of disulfide-linked HLA-G dimer in mice with collagen-induced arthritis. Hum Immunol. 2013;74:433–8.

    Google Scholar 

  49. Ostensen M, Forger F, Nelson JL, Schuhmacher A, Hebisch G, Villiger PM. Pregnancy in patients with rheumatic disease: anti-inflammatory cytokines increase in pregnancy and decrease post partum. Ann Rheum Dis. 2005;64:839–44.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  50. Nelson JL, Hughes KA, Smith AG, Nisperos BB, Branchaud AM, Hansen JA. Maternal-fetal disparity in HLA class II alloantigens and the pregnancy-induced amelioration of rheumatoid arthritis. N Engl J Med. 1993;329:466–71.

    Article  PubMed  CAS  Google Scholar 

  51. van der Horst-Bruinsma IE, De Vries RR, de Buck PD, van Schendel PW, Breedveld FC, Schreuder GM, et al. Influence of HLA-class II incompatibility between mother and fetus on the development and course of rheumatoid arthritis of the mother. Ann Rheum Dis. 1998;57:286–90.

    Article  PubMed  Google Scholar 

  52. Zenclussen AC, Gerlof K, Zenclussen ML, Ritschel S, Zambon BA, Fest S, et al. Regulatory T cells induce a privileged tolerant microenvironment at the fetal-maternal interface. Eur J Immunol. 2006;36:82–94.

    Article  PubMed  CAS  Google Scholar 

  53. Forger F, Marcoli N, Gadola S, Moller B, Villiger PM, Ostensen M. Pregnancy induces numerical and functional changes of CD4 + CD25 high regulatory T cells in patients with rheumatoid arthritis. Ann Rheum Dis. 2008;67:984–90.

    Article  PubMed  CAS  Google Scholar 

  54. Ostensen M, Ostensen H. Ankylosing spondylitis—the female aspect. J Rheumatol. 1998;25:120–4.

    PubMed  CAS  Google Scholar 

  55. Micu MC, Micu R, Ostensen M. Luteinized unruptured follicle syndrome increased by inactive disease and selective cyclooxygenase 2 inhibitors in women with inflammatory arthropathies. Arthritis Care Res (Hoboken). 2011;63:1334–8.

    Article  CAS  Google Scholar 

  56. Ostensen M. Pregnancy in psoriatic arthritis. Scand J Rheumatol. 1988;17:67–70.

    Article  PubMed  CAS  Google Scholar 

  57. Ostensen M, Ostensen H. Safety of nonsteroidal antiinflammatory drugs in pregnant patients with rheumatic disease. J Rheumatol. 1996;23:1045–9.

    PubMed  CAS  Google Scholar 

  58. Gran JT, Ostensen M. Spondyloarthritides in females. Baillieres Clin Rheumatol. 1998;12:695–715.

    Article  PubMed  CAS  Google Scholar 

  59. Ostensen M, Husby G. Ankylosing spondylitis and pregnancy. Rheum Dis Clin North Am. 1989;15:241–54.

    PubMed  CAS  Google Scholar 

  60. Jang JH, Ward MM, Rucker AN, Reveille JD, Davis Jr JC, Weisman MH, et al. Ankylosing spondylitis: patterns of radiographic involvement—a re-examination of accepted principles in a cohort of 769 patients. Radiology. 2011;258:192–8.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Ostensen M, Romberg O, Husby G. Ankylosing spondylitis and motherhood. Arthritis Rheum. 1982;25:140–3.

    Article  PubMed  CAS  Google Scholar 

  62. Ostensen M, Husby G. Pregnancy and rheumatic disease. A review of recent studies in rheumatoid arthritis and ankylosing spondylitis. Klin Wochenschr. 1984;62:891–5.

    Article  PubMed  CAS  Google Scholar 

  63. Carmichael SL, Yang W, Feldkamp ML, Munger RG, Siega-Riz AM, Botto LD, et al. Reduced risks of neural tube defects and orofacial clefts with higher diet quality. Arch Pediatr Adolesc Med. 2012;166:121–6.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Chandler AL, Hobbs CA, Mosley BS, Berry RJ, Canfield MA, Qi YP, et al. Neural tube defects and maternal intake of micronutrients related to one-carbon metabolism or antioxidant activity. Birth Defects Res A Clin Mol Teratol. 2012;94:864–74.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  65. Ostensen M, Motta M. Therapy insight: the use of antirheumatic drugs during nursing. Nat Clin Pract Rheumatol. 2007;3:400–6.

    Article  PubMed  Google Scholar 

  66. Wasserman BR, Moskovich R, Razi AE. Rheumatoid arthritis of the cervical spine—clinical considerations. Bull NYU Hosp Jt Dis. 2011;69:136–48.

    PubMed  Google Scholar 

  67. Hoffman SL, Zaphiratos V, Girard MA, Boucher M, Crochetiere C. Failed epidural analgesia in a parturient with advanced ankylosing spondylitis: a novel explanation. Can J Anaesth. 2012;59:871–4.

    Article  PubMed  Google Scholar 

  68. Too CL, Yahya A, Murad S, Dhaliwal JS, Larsson PT, Muhamad NA, et al. Smoking interacts with HLA-DRB1 shared epitope in the development of anti-citrullinated protein antibody-positive rheumatoid arthritis: results from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis (MyEIRA). Arthritis Res Ther. 2012;14:R89.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  69. Joshi R, Reveille JD, Brown MA, Weisman MH, Ward MM, Gensler LS, et al. Is there a higher genetic load of susceptibility loci in familial ankylosing spondylitis? Arthritis Care Res (Hoboken). 2012;64:780–4.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Rheumatology, National Service for Pregnancy and Rheumatic Disease, University Hospital of Trondheim, Bevegelsessenteret, Olav Kyrres gt 13, 7006, Trondheim, Norway

    Monika Østensen M.D. & Marianne Wallenius M.D., Ph.D.

  2. Institute of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway

    Marianne Wallenius M.D., Ph.D.

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  1. Monika Østensen M.D.
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  2. Marianne Wallenius M.D., Ph.D.
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Correspondence to Monika Østensen M.D. .

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Editors and Affiliations

  1. Division of Rheumatology, Hospital for Special Surgery Weill Cornell Medical College, New York, New York, USA

    Lisa R. Sammaritano

  2. Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Bonnie L. Bermas

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Østensen, M., Wallenius, M. (2014). Rheumatoid Arthritis and Seronegative Spondyloarthropathy. In: Sammaritano, L., Bermas, B. (eds) Contraception and Pregnancy in Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0673-4_7

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  • DOI: https://doi.org/10.1007/978-1-4939-0673-4_7

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