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Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use.

Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, Louis E, Masson P, De Keyser F - Rheumatology (Oxford) (2011)

Bottom Line: This article aims to summarize the current evidence on the evolution of RA disease activity during and after pregnancy and the use of anti-rheumatic drugs around this period.Of recent interest is the potential use of anti-TNF compounds in the preconception period and during pregnancy.Accumulating experience with anti-TNF therapy in other immune-mediated inflammatory diseases, such as Crohn's disease, provides useful insights for the use of TNF blockade in pregnant women with RA, or RA patients wishing to become pregnant.

View Article: PubMed Central - PubMed

Affiliation: Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

ABSTRACT
It has long been known that pregnancy and childbirth have a profound effect on the disease activity of rheumatic diseases. For clinicians, the management of patients with RA wishing to become pregnant involves the challenge of keeping disease activity under control and adequately adapting drug therapy during pregnancy and post-partum. This article aims to summarize the current evidence on the evolution of RA disease activity during and after pregnancy and the use of anti-rheumatic drugs around this period. Of recent interest is the potential use of anti-TNF compounds in the preconception period and during pregnancy. Accumulating experience with anti-TNF therapy in other immune-mediated inflammatory diseases, such as Crohn's disease, provides useful insights for the use of TNF blockade in pregnant women with RA, or RA patients wishing to become pregnant.

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Mechanisms of feto-maternal tolerance. Pregnancy is a situation of induced immunological tolerance in the mother against the semi-allogeneic fetus. The immunological mechanisms responsible for this state of tolerance consist of local components, triggered by trophoblast-induced changes in uterine cytokine profile, decreased T- and NK-cell function and complement activation. In addition, systemic changes in immune function during pregnancy include progesterone-induced thymus involution, decreased NK-cell activity and a shift towards a more Th2-dominated immune-response pattern. KIR: killer cell immunoglobulin-like receptor; uNK: uterine natural killer cell.
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ker302-F1: Mechanisms of feto-maternal tolerance. Pregnancy is a situation of induced immunological tolerance in the mother against the semi-allogeneic fetus. The immunological mechanisms responsible for this state of tolerance consist of local components, triggered by trophoblast-induced changes in uterine cytokine profile, decreased T- and NK-cell function and complement activation. In addition, systemic changes in immune function during pregnancy include progesterone-induced thymus involution, decreased NK-cell activity and a shift towards a more Th2-dominated immune-response pattern. KIR: killer cell immunoglobulin-like receptor; uNK: uterine natural killer cell.

Mentions: Pregnancy is a situation of induced immunological tolerance in the mother against the semi-allogeneic fetus. Immunological changes in pregnancy necessary for this so-called feto-maternal tolerance are summarized in Fig. 1 and include thymic involution [45], decreased NK-cell function [46], and a decrease in Th1 immune response shifting towards a more Th2-dominated immune response pattern [17, 31, 47], whereas T- and B-cell numbers, antibody production and response to vaccines do not change during pregnancy.Fig. 1


Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use.

Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, Louis E, Masson P, De Keyser F - Rheumatology (Oxford) (2011)

Mechanisms of feto-maternal tolerance. Pregnancy is a situation of induced immunological tolerance in the mother against the semi-allogeneic fetus. The immunological mechanisms responsible for this state of tolerance consist of local components, triggered by trophoblast-induced changes in uterine cytokine profile, decreased T- and NK-cell function and complement activation. In addition, systemic changes in immune function during pregnancy include progesterone-induced thymus involution, decreased NK-cell activity and a shift towards a more Th2-dominated immune-response pattern. KIR: killer cell immunoglobulin-like receptor; uNK: uterine natural killer cell.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3198908&req=5

ker302-F1: Mechanisms of feto-maternal tolerance. Pregnancy is a situation of induced immunological tolerance in the mother against the semi-allogeneic fetus. The immunological mechanisms responsible for this state of tolerance consist of local components, triggered by trophoblast-induced changes in uterine cytokine profile, decreased T- and NK-cell function and complement activation. In addition, systemic changes in immune function during pregnancy include progesterone-induced thymus involution, decreased NK-cell activity and a shift towards a more Th2-dominated immune-response pattern. KIR: killer cell immunoglobulin-like receptor; uNK: uterine natural killer cell.
Mentions: Pregnancy is a situation of induced immunological tolerance in the mother against the semi-allogeneic fetus. Immunological changes in pregnancy necessary for this so-called feto-maternal tolerance are summarized in Fig. 1 and include thymic involution [45], decreased NK-cell function [46], and a decrease in Th1 immune response shifting towards a more Th2-dominated immune response pattern [17, 31, 47], whereas T- and B-cell numbers, antibody production and response to vaccines do not change during pregnancy.Fig. 1

Bottom Line: This article aims to summarize the current evidence on the evolution of RA disease activity during and after pregnancy and the use of anti-rheumatic drugs around this period.Of recent interest is the potential use of anti-TNF compounds in the preconception period and during pregnancy.Accumulating experience with anti-TNF therapy in other immune-mediated inflammatory diseases, such as Crohn's disease, provides useful insights for the use of TNF blockade in pregnant women with RA, or RA patients wishing to become pregnant.

View Article: PubMed Central - PubMed

Affiliation: Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

ABSTRACT
It has long been known that pregnancy and childbirth have a profound effect on the disease activity of rheumatic diseases. For clinicians, the management of patients with RA wishing to become pregnant involves the challenge of keeping disease activity under control and adequately adapting drug therapy during pregnancy and post-partum. This article aims to summarize the current evidence on the evolution of RA disease activity during and after pregnancy and the use of anti-rheumatic drugs around this period. Of recent interest is the potential use of anti-TNF compounds in the preconception period and during pregnancy. Accumulating experience with anti-TNF therapy in other immune-mediated inflammatory diseases, such as Crohn's disease, provides useful insights for the use of TNF blockade in pregnant women with RA, or RA patients wishing to become pregnant.

Show MeSH
Related in: MedlinePlus