Pregnancy rheumatoid arthritis

Endocrine factors. Most autoimmune diseases occur with unequal frequency in males and females. For example. Graves and Hashimoto s are 4-5 times, and SLE 10 times, more common in females, while ankylosing spondylitis is 3-4 times more frequent in males. These differences are believed to be the result of hormonal influences. A second well-documented hormonal effect is the marked reduction in disease severity seen in many autoimmune conditions during pregnancy. Rheumatoid arthritis is perhaps the classic example of this effect. In some cases there is also a rapid exacerbation (rebound) after birth. 

In view of the facts that pregnancy may cause remission of rheumatoid arthritis and that the hormones cortisone and ACTH have been found effective in treatment, it is desirable to mention a point... 

History of penicillamine-related aplastic anemia or agranulocytosis rheumatoid arthritis patients with a history or other evidence of renal insufficiency pregnancy breastfeeding. 

Hypersensitivity to azathioprine pregnancy in rheumatoid arthritis patients. 

It has become apparent that reduction in the dose of the constituents of oral contraceptives has markedly reduced mild and severe adverse effects, providing a relatively safe and convenient method of contraception for many young women. Treatment with oral contraceptives has also been shown to be associated with many benefits unrelated to contraception. These include a reduced risk of ovarian cysts, ovarian and endometrial cancer, and benign breast disease. There is a lower incidence of ectopic pregnancy. Iron deficiency and rheumatoid arthritis are less common, and premenstrual symptoms, dysmenorrhea, endometriosis, acne, and hirsutism may be ameliorated with their use. 

An interesting application of this interaction is seen with the use of leflunomide (Arava) in the treatment of rheumatoid arthritis. Leflunomide can cause fetal harm if administered during pregnancy, and it has an active metabolite that can persist in the system for at least 2 years. If a woman of childbearing potential discontinues use of leflunomide, it is recommended that cholestyramine (8 g 3 times a day for 11 days) be used to accelerate the elimination of the drug and its active metabolite. 

A boy whose mother had taken T. wiifordii for rheumatoid arthritis early in her pregnancy was born with an... 

Whereas the benefits of penicillamine outweigh the risk in patients with Wilson s disease and probably cysteinuria, there have been a few reports of congenital injury attributed to the use of penicillamine, notably congenital cutis hyperelastica with a fatal course in three infants. Penicillamine should be withdrawn during pregnancy in patients with rheumatoid arthritis (383-385). It should be added, however, that in Wilson s disease it is also worth considering if it is possible to control copper metabolism with less penicillamine or without it altogether. 

Hyperutilization of folic acid may occur when the rate of cellular division is increased as is seen during pregnancy hemolytic anemia myelofibrosis mahgnancy chronic inflammatory disorders such as Crohn s disease, rheumatoid arthritis, or psoriasis long-term dialysis burn patients and growth spurts seen in adolescence and infancy. This can lead to anemia, particularly when the daily intake of folate is borderline, resulting in inadequate replacement of folate stores. 

Copper Neutropenia, leukopenia, hypochromic anemia, osteoporosis, hair and skin depigmentation, dermatitis, anorexia, diarrhea, mental deterioration, hypercholesterolemia Wilson s disease liver cirrhosis, diarrhea, vomiting, metallic taste Decreased high iron or vitamin C intake, corticosteroid use Increased infection, rheumatoid arthritis, pregnancy, oral contraceptives, decreased biliary excretion... 

Drossaers-Bakker KW, Zwinderman AH, van Zeben D, Breedveld FC, Hazes JM (2002) Pregnancy and oral contraceptive use do not significantly influence outcome in long term rheumatoid arthritis. Ann Rheum Dis, 61 405-408. 

Silman AJ, Kay A, Brennan P (1992) Timing of pregnancy in relation to the onset of rheumatoid arthritis. Arthritis Rheum, 35 152-155. 

Indications Chronic bi patterns, liver/kidney dual deficiency, qi and blood insufficiency. Chronic rheumatoid arthritis, osteoarthritis, rheumatic sciatica, lumbar strain, lumbar intervertebral disc herniation, pain in the midline and back during pregnancy, hemiplegia due to stroke, and the sequelae of poliomyelitis... 

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