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Daraghmeh DN, Hopkins AM, King C, Abuhelwa AY, Wechalekar MD, Proudman SM, Sorich MJ, Wiese MD. Female reproductive status and exogenous sex hormone use in rheumatoid arthritis patients treated with tocilizumab and csDMARDs. Rheumatology (Oxford) 2023; 62:583-595. [PMID: 35731132 PMCID: PMC9891436 DOI: 10.1093/rheumatology/keac357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Sex is well known to influence risk, severity and treatment outcomes of RA, although the underlying causes are uncertain. The aim of this research was to examine whether factors influencing female sex hormones (reproductive status and exogenous sex hormone use) are associated with the efficacy of DMARDs. METHODS Individual participant data were pooled from five phase 3 clinical trials where RA patients were treated with tocilizumab and/or conventional synthetic DMARDs. The primary outcome was the time to first remission according to the Simplified Disease Activity Index. The relationship between menopausal status or use of exogenous sex hormones and the time of first remission was assessed via Cox proportional analysis. Analysed data included sex, baseline menopausal status (premenopausal, perimenopausal, early postmenopausal and postmenopausal), participant age, body mass index, race, number of previous DMARDs and baseline disease activity. RESULTS Analysis included 4474 female patients, of whom 2817 (62.9%) were postmenopausal, 202 (4.5%) were early postmenopausal, 1021 (22.8%) were premenopausal and 414 (9.2%) were perimenopausal. Of these, 221 (7.8%), 13 (6.4%), 255 (25%) and 47 (11.4%), respectively, were taking exogenous sex hormones. In the pooled analysis, perimenopausal status was associated with reduced remission compared with premenopausal status [adjusted HR 0.78 (95% CI 0.61, 0.99)]. Sex hormone use was associated with significantly higher remission [adjusted HR 1.20 (95% CI 1.01, 1.43)]. CONCLUSION Perimenopausal women were less likely to achieve remission compared with premenopausal RA patients. The use of exogenous sex hormones appeared to be associated with more frequent remission in female RA patients, particularly those who were perimenopausal and early postmenopausal, although further research is required to confirm and identify the drivers for this observation and how it interacts with menopausal status.
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Affiliation(s)
- Dala N Daraghmeh
- Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide
| | - Ashley M Hopkins
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Catherine King
- Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide
| | - Ahmad Y Abuhelwa
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Mihir D Wechalekar
- Rheumatology Research Unit, Repatriation General Hospital and Flinders University
| | - Susanna M Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia
| | - Michael J Sorich
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Michael D Wiese
- Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide
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Alpizar-Rodriguez D, Förger F, Courvoisier DS, Gabay C, Finckh A. Role of reproductive and menopausal factors in functional and structural progression of rheumatoid arthritis: results from the SCQM cohort. Rheumatology (Oxford) 2020; 58:432-440. [PMID: 30380120 DOI: 10.1093/rheumatology/key311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/02/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To study the relationship between female reproductive and menopausal factors on functional and structural joint damage progression in women with RA. METHODS This is an observational cohort study of RA patients enrolled in the Swiss Clinical Quality Management Program for Rheumatoid Arthritis. Information about female hormonal factors, such as pregnancies, menopause and hormonal therapy, were retrospectively retrieved using a specific questionnaire. The primary outcome was functional disability progression (HAQ) and the secondary outcome radiographic joint damage progression. We compared the functional progression between pre- and post-menopausal women using a multilevel regression model for longitudinal data, adjusting for potential confounders, such as baseline age, years of education, disease duration, seropositivity, DAS28 and treatment. RESULTS A total of 1667 women were analysed, of whom 1025 (61%) were post-menopausal. Participants had a median of 6 HAQ assessments (interquartile range 3-10) during 5.1 (interquartile range 2.2-9.8) years of follow-up. At baseline, post-menopausal women had higher HAQ and erosion scores than pre-menopausal women. The evolution of HAQ scores over time differed between pre- and post-menopausal women (P < 0.001), with a less favourable evolution in post-menopausal women, particularly with earlier age at menopause. Erosion progression did not differ between pre- and post-menopausal women. CONCLUSION In women with RA, functional disability progression differed between pre- and post-menopausal women. The more favourable evolution of function in pre-menopausal women was not explained by disease duration, age or radiographic damage.
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Affiliation(s)
- Deshire Alpizar-Rodriguez
- Department of Internal Medicine Specialties, Division of Rheumatology, University Hospitals of Geneva, Switzerland
| | - Frauke Förger
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Switzerland
| | - Delphine Sophie Courvoisier
- Department of Internal Medicine Specialties, Division of Rheumatology, University Hospitals of Geneva, Switzerland
| | - Cem Gabay
- Department of Internal Medicine Specialties, Division of Rheumatology, University Hospitals of Geneva, Switzerland
| | - Axel Finckh
- Department of Internal Medicine Specialties, Division of Rheumatology, University Hospitals of Geneva, Switzerland
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Harris N, Eudy A, Clowse M. Patient-Reported Disease Activity and Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus and Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 71:390-397. [DOI: 10.1002/acr.23621] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/12/2018] [Indexed: 01/23/2023]
Affiliation(s)
| | - Amanda Eudy
- Duke University Medical Center; Durham North Carolina
| | - Megan Clowse
- Duke University Medical Center; Durham North Carolina
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Krasselt M, Baerwald C. Sex, Symptom Severity, and Quality of Life in Rheumatology. Clin Rev Allergy Immunol 2017; 56:346-361. [DOI: 10.1007/s12016-017-8631-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Atta DS, Girbash EF, Abdelwahab SM, Abdeldayem HM, Tharwat I, Ghonaim R. Maternal cytokines and disease severity influence pregnancy outcomes in women with rheumatoid arthritis. J Matern Fetal Neonatal Med 2016; 29:3358-63. [PMID: 26629845 DOI: 10.3109/14767058.2015.1127342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the influence of maternal cytokine levels, disease activity and severity on preterm delivery, small for gestational age (SGA) and cesarean delivery in pregnant women with rheumatoid arthritis (RA). METHODS A prospective study in 47 pregnant women with RA and 22 healthy pregnant controls. The main outcome measures were birth weight in relation to maternal serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and RA activity and severity at three different time points: preconception and during the first and third trimesters. RESULTS During the third trimester, IL-10 was detectable in 23.4% of patients with RA, IL-6 in 76.6%. Mean birth weight born to mothers with RA was higher when IL-10 level was high compared with low (p = 0.001), and lower when IL-6 was high compared with low (p = 0.035). Also increase in disease activity score-28 (in 60.1%, p = 0.001), Health Assessment Questionnaire-Disability Index (in 87.5%, p = 0.013), and pain score (56.9 ± 11.4, p = 0.003) associated with increased risk of SGA. High patient's global scale was associated with unfavorable pregnancy outcome (preterm, SGA, and cesarean). CONCLUSION High maternal IL-10 levels are associated with higher birth weight and high IL-6 levels are associated with lower birth weight (SGA). Among women with RA, disease activity and severity are predictive of unfavorable pregnancy outcomes suggesting that better disease management early in the pregnancy could improve pregnancy outcomes.
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Affiliation(s)
- Doaa S Atta
- a Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University , Zagazig , Egypt
| | - Ehab F Girbash
- b Obstetrics and Gynecology, Faculty of Medicine, Zagazig University , Zagazig , Egypt .,c Najd Consulting Hospital , Riyadh , Saudi Arabia , and
| | - Shaimaa M Abdelwahab
- a Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University , Zagazig , Egypt
| | - Hussein M Abdeldayem
- b Obstetrics and Gynecology, Faculty of Medicine, Zagazig University , Zagazig , Egypt
| | - Ibrahim Tharwat
- a Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University , Zagazig , Egypt
| | - Rania Ghonaim
- d Clinical Pathology, Faculty of Medicine, Zagazig University , Zagazig , Egypt
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Druce KL, Jones GT, Macfarlane GJ, Verstappen SM, Basu N. The Longitudinal Course of Fatigue in Rheumatoid Arthritis: Results from the Norfolk Arthritis Register. J Rheumatol 2015; 42:2059-65. [DOI: 10.3899/jrheum.141498] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 01/09/2023]
Abstract
Objective.Fatigue is common and burdensome in rheumatoid arthritis (RA). Despite RA fatigue progression varying significantly between individuals in practice, existing longitudinal analyses only examine symptom advancement on a population level. This study aimed to determine fatigue trajectories at an individual level and to characterize those patients with the poorest prognosis, with a view to enabling earlier interventions.Methods.Patients with RA reporting clinically relevant baseline fatigue (≥ 20 mm on a 0–100 mm visual analog scale) were identified from a longterm inflammatory polyarthritis cohort (the Norfolk Arthritis Register). Fatigue changes from baseline to 1- and 4-year followups were calculated, and sex-stratified group-based trajectory modeling (GBTM) determined trajectories of the symptom between which baseline characteristics were compared.Results.Among 338 patients, only minimal average changes were observed between recruitment to 1 year (6.0 mm, SD 26.9) and 4 years (5.5 mm, SD 29.3). This was despite 45.6% and 40.7% of participants reporting clinically significant improvements (≥ 10 mm) at these respective followups. GBTM revealed varied trajectories of fatigue, which for both sexes consisted of Improved (men, n = 48 and women, n = 81) or persistent Moderate-high paths (n = 54, n = 105), and further included a persistent High trajectory in women (n = 50). Participants who followed persistent trajectories were best distinguished from improvers by patient-reported rather than demographic or clinical variables.Conclusion.Among patients with RA presenting with clinically relevant fatigue, distinct longitudinal symptom trajectories were identified on an individual level despite nominal average changes in fatigue on a group level. It is possible to identify and characterize subgroups of participants who report persistent fatigue and should therefore be targeted to receive future fatigue-alleviating interventions.
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Bharti B, Lee SJ, Lindsay SP, Wingard DL, Jones KL, Lemus H, Chambers CD. Disease Severity and Pregnancy Outcomes in Women with Rheumatoid Arthritis: Results from the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project. J Rheumatol 2015; 42:1376-82. [PMID: 25877497 DOI: 10.3899/jrheum.140583] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the effect of rheumatoid arthritis (RA) disease severity on pregnancy outcomes in pregnant women with and without autoimmune diseases. METHODS A prospective cohort study was conducted using the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project. Pregnant women with RA enrolled between 2005 and 2013 were selected if they (1) delivered a live-born singleton infant; and (2) completed 3 telephone-based measures of RA disease severity prior to 20 weeks' gestation, including the Health Assessment Questionnaire Disability Index (HAQ-DI), pain score, and patient's global scale. Associations between RA disease severity and preterm delivery, small for gestational age (SGA), or cesarean delivery were tested in unadjusted and multivariate analyses using modified Poisson regression models. RESULTS The sample consisted of 440 women with RA. Several unadjusted comparisons yielded significant associations. After adjustment for covariates, increasing disease severity was associated with risk for preterm delivery and SGA. For each unit increase in HAQ-DI (0-1), the adjusted relative risk (aRR) for preterm delivery increased by 58% (aRR 1.58, 95% CI 1.17-2.15). Among those with HAQ-DI > 0.5, the aRR for SGA was 1.81 (95% CI 1.01-3.33). CONCLUSION RA disease severity in early pregnancy, as measured in this study, was predictive of preterm delivery and SGA. These findings suggest that the risk of preterm delivery and SGA in women with RA might be lowered if RA is well controlled early in pregnancy.
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Affiliation(s)
- Balambal Bharti
- From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego.
| | - Susan J Lee
- From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego
| | - Suzanne P Lindsay
- From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego
| | - Deborah L Wingard
- From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego
| | - Kenneth L Jones
- From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego
| | - Hector Lemus
- From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego
| | - Christina D Chambers
- From the departments of Pediatrics, Medicine, and Family and Preventive Medicine, University of California San Diego; Graduate School of Public Health, San Diego State University; San Diego Veterans Affairs Medical Center, San Diego, California, USA.B. Bharti, MBBS, MPH, PhD, Doctoral Candidate University of California San Diego and San Diego State University Joint Doctoral Program, Department of Pediatrics and Department of Family and Preventive Medicine, University of California San Diego, and Graduate School of Public Health, San Diego State University; S.J. Lee, MD, Associate Professor, Department of Medicine, University of California San Diego, and San Diego Veterans Affairs Medical Center; S.P. Lindsay, PhD, Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; D.L. Wingard, PhD, Professor and Associate Chief, Division of Epidemiology, Department of Family and Preventive Medicine University of California San Diego; K.L. Jones, MD, Professor and Chief, Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego; H. Lemus, PhD, Assistant Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; C.D. Chambers, PhD, MPH, Professor, Department of Pediatrics, and Family and Preventive Medicine Director, Center for Promotion of Maternal Health and Infant Development, University of California San Diego
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Murakawa Y. [Serious organ damage and intractable clinical conditions in rheumatic and connective tissue disease--progress in pathophysiology and treatment. Topics: II. Clinical conditions special attention needed to be paid to; 5. Pregnancy in autoimmune rheumatic diseases]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2013; 102:2645-2652. [PMID: 24400546 DOI: 10.2169/naika.102.2645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
MESH Headings
- Abnormalities, Drug-Induced/etiology
- Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
- Anti-Inflammatory Agents, Non-Steroidal/adverse effects
- Anti-Inflammatory Agents, Non-Steroidal/metabolism
- Antirheumatic Agents/administration & dosage
- Antirheumatic Agents/adverse effects
- Antirheumatic Agents/metabolism
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/drug therapy
- Female
- Glucocorticoids/administration & dosage
- Glucocorticoids/adverse effects
- Glucocorticoids/metabolism
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/therapy
- Immunoglobulin G/metabolism
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/metabolism
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/drug therapy
- Maternal-Fetal Exchange
- Pregnancy
- Pregnancy Complications/drug therapy
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Affiliation(s)
- Yohko Murakawa
- Department of Rheumatology, Shimane University Faculty of Medicine, Japan
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31824bc119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Berencsi G, Takács M. Barriers of the Human Organism and Their Achilles’ Heels. MATERNAL FETAL TRANSMISSION OF HUMAN VIRUSES AND THEIR INFLUENCE ON TUMORIGENESIS 2012. [PMCID: PMC7121758 DOI: 10.1007/978-94-007-4216-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The human body is covered by barriers separating it from the external and internal surroundings. The “milieu enterieur” has to be stabilised in spite of the variable external and internal conditions of toxic, osmotic, microbial and climatic environmental circumstances. This first line of barriers is composed of skin and mucous membranes of complicated structures. A second line of barrier system is present in our organisms. Certain organs have to be separated from the immune system and other parts of the body because of evolutionary reasons (eye-bulb and testicles) because of unique proteins “unknown” for the acquired immune system. The blood-brain barrier (BBB) is providing enhanced safety circumstances for the central nervous system. The second line of barriers is represented by the special properties of the capillary endothelial system. The maternal-fetal barrier is the most complex. At the maternal fetal interface two individuals of two different haplotypes has to be live 9 months separated by a very complicated dynamic barrier. The placenta is the organ, which is separating the maternal and fetal tissues. Similar to others the bidirectional transport of gasses, metabolites, cells, proteins, regulatory substances, are transported by active or passive transcellular and intercellular mechanisms. The fetal immune system develops immunotolerance to all maternal cells and antigens transferred transplacentally. The problem is to mitigate the maternal immune system to tolerate the paternal haplotype of the fetus. In the case of normal pregnancy a complex series of physiological modifications can solve the problem without harmful consequences to the mother and fetus. The outermost contact cells of trophoblasts express instead of HLA-class Ia and class II antigens non-variable HLA-C, HLA-E, HLA-F and HLA-G antigens. The first consequence of this is reduction of the activity of maternal natural killer cells and maternal dendritic cells; Progesteron, micro-RNA and mediators influence the development of T effector-cells. The production of soluble HLA-G(5 and 6) and IL-10 supports the differentiation of Th-2 CD4+ helper cells, reducing the ability of maternal cells to kill fetal cells. Series of receptors and costimulators are expressed by the different lines of semi-allogenic trophoblast cells to bind HLA-G and mitigate maternal immune response; The maternal immunotolerance is further facilitated by the activation of CD4+CD25brightFoxp3+ regulatory T (TREG) cells. Infections have to be prevented during pregnancy. The cells of placenta express 10 Toll-like receptors a group of pattern recognition receptors responsible for innate immunity. The interferon level is also higher in the placental tissues than in the somatic fetal or maternal cells. The complement system is also adapted to the requirements of the pregnancy and fetal damage is inhibited by the production of “assymmetric IgG antibodies” under hormonal and placental-regulation. These modifications prevent the activation of complement, cytotoxic activity, opsonising ability, antigen clearance and precipitating activity of the molecules. The Achilles’ heels of the different barriers are regularly found by virus infections. Lamina cribrosa of the blood-brain barrier, optical nerve of the eyes, etc. the risk factors of the maternal-fetal barrier has been summarised in Table 1.1.
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Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, Louis E, Masson P, De Keyser F. Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use. Rheumatology (Oxford) 2011; 50:1955-68. [PMID: 21890617 PMCID: PMC3198908 DOI: 10.1093/rheumatology/ker302] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 07/19/2011] [Indexed: 12/13/2022] Open
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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Affiliation(s)
- Johanna M.W. Hazes
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, de Duve Institute, Université Catholique de Louvain, Brussels, Center of Immunology, Institute of Pathology, University of Liège, Liège, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium, Gastroentérologie, Hôpital du Bicetre, Paris, France, Gastroenterology, CHU and University of Liege, Liège and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Pierre G. Coulie
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, de Duve Institute, Université Catholique de Louvain, Brussels, Center of Immunology, Institute of Pathology, University of Liège, Liège, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium, Gastroentérologie, Hôpital du Bicetre, Paris, France, Gastroenterology, CHU and University of Liege, Liège and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Vincent Geenen
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, de Duve Institute, Université Catholique de Louvain, Brussels, Center of Immunology, Institute of Pathology, University of Liège, Liège, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium, Gastroentérologie, Hôpital du Bicetre, Paris, France, Gastroenterology, CHU and University of Liege, Liège and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Séverine Vermeire
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, de Duve Institute, Université Catholique de Louvain, Brussels, Center of Immunology, Institute of Pathology, University of Liège, Liège, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium, Gastroentérologie, Hôpital du Bicetre, Paris, France, Gastroenterology, CHU and University of Liege, Liège and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Franck Carbonnel
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, de Duve Institute, Université Catholique de Louvain, Brussels, Center of Immunology, Institute of Pathology, University of Liège, Liège, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium, Gastroentérologie, Hôpital du Bicetre, Paris, France, Gastroenterology, CHU and University of Liege, Liège and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Edouard Louis
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, de Duve Institute, Université Catholique de Louvain, Brussels, Center of Immunology, Institute of Pathology, University of Liège, Liège, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium, Gastroentérologie, Hôpital du Bicetre, Paris, France, Gastroenterology, CHU and University of Liege, Liège and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Pierre Masson
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, de Duve Institute, Université Catholique de Louvain, Brussels, Center of Immunology, Institute of Pathology, University of Liège, Liège, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium, Gastroentérologie, Hôpital du Bicetre, Paris, France, Gastroenterology, CHU and University of Liege, Liège and Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Filip De Keyser
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands, de Duve Institute, Université Catholique de Louvain, Brussels, Center of Immunology, Institute of Pathology, University of Liège, Liège, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium, Gastroentérologie, Hôpital du Bicetre, Paris, France, Gastroenterology, CHU and University of Liege, Liège and Department of Rheumatology, Ghent University, Ghent, Belgium
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Camacho EM, Lunt M, Farragher TM, Verstappen SMM, Bunn DK, Symmons DPM. The relationship between oral contraceptive use and functional outcome in women with recent-onset inflammatory polyarthritis: results from the Norfolk Arthritis Register. ACTA ACUST UNITED AC 2011; 63:2183-91. [PMID: 21520011 DOI: 10.1002/art.30416] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Use of oral contraceptives (OCs) may prevent the development of rheumatoid arthritis, but the influence of OC use on disease outcome is unresolved. The purpose of this study was to examine functional outcome and OC use in women with inflammatory polyarthritis (IP). METHODS The Norfolk Arthritis Register (NOAR) is an inception cohort of patients with recent-onset IP. We studied patient-reported history of OC use in 663 women who were born after 1945 and who had not used OCs during followup. OC use during followup was additionally investigated in 265 women who were <50 years old and had not undergone menopause or hysterectomy during followup. All patients were recruited to the NOAR between 1990 and 2004. Functional ability was assessed using the Health Assessment Questionnaire (HAQ), with adjustment for age at symptom onset. RESULTS The median followup was 4.9 years. In the investigation analyzing OC use before symptom onset, patients who had used OCs before symptom onset had lower HAQ scores throughout followup than patients who had not taken OCs before symptom onset (difference in score at 5-year followup -0.35; 95% confidence interval [95% CI] -0.51, -0.19). Patients who were taking OCs at baseline had lower HAQ scores over time than women who were not taking OCs at baseline but had previously done so (mean difference -0.21; 95% CI -0.40, -0.02). In the investigation analyzing OC use during followup, OC use during followup was associated with lower HAQ scores over time than no OC use during followup (mean difference -0.06; 95% CI -0.16, 0.03); however, this was only significant for women with moderate or severe functional disability at the previous assessment (mean difference -0.23; 95% CI -0.40, -0.07). Further adjustment for potential confounders and exclusion of hormone replacement therapy users had little impact. CONCLUSION OC use is generally associated with a beneficial functional outcome in IP, and use before and at symptom onset appeared to have the most consistent benefit.
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Affiliation(s)
- E M Camacho
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
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15
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Camacho EM, Harrison M, Farragher TM, Lunt M, Bunn DK, Verstappen SMM, Symmons DPM. Parity, time since last live birth and long-term functional outcome: a study of women participating in the Norfolk Arthritis Register. Ann Rheum Dis 2011; 70:642-5. [PMID: 21372194 PMCID: PMC3211466 DOI: 10.1136/ard.2010.140301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the relationship between pre-symptom onset live births and functional outcome in women with inflammatory polyarthritis (IP). METHODS 1872 women with no subsequent pregnancies were registered with the Norfolk Arthritis Register between 1990 and 2004 and followed-up for a median of 5 years. Functional disability over time was assessed by Health Assessment Questionnaire (HAQ). The number and calendar year of past live births were recorded. Differences in HAQ score over time by parity and time since last live birth (latency), adjusted for age and symptom duration, were examined using linear random effects models. The results were then adjusted for a number of potential confounders. RESULTS 1553 women (83%) had ≥1 live births before symptom onset. The median latency was 26 years (IQR 16-35). Parous women had significantly lower HAQ scores over time than nulliparous women (-0.19, 95% CI -0.32 to -0.06). Increasing latency was associated with increasing HAQ score; the mean HAQ score of women with a latency of approximately 32 years was the same as for nulliparous women. This was independent of autoantibody status, socioeconomic status, smoking history and comorbidity. CONCLUSION Parous women who develop IP have better functional outcome over time than nulliparous women who develop IP. The beneficial effect of parity diminishes with time.
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Affiliation(s)
- E M Camacho
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
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Abstract
Women are more likely than men to develop rheumatoid arthritis (RA), and recent data suggest that they also suffer greater disability than men with this disease. The reasons for these sexually dimorphic patterns of disease incidence and progression are unknown, but investigations into the underlying mechanisms could provide useful insights into RA pathogenesis and may also suggest new treatment approaches. The processes of sexual differentiation involve genetic input, gonadal hormone signaling and responses from target cells and tissues. Layered upon these processes are behavioral characteristics of males and females acquired as a result of their social context. Differences in disease presentation between the sexes could be the result of complex combinations of all these factors. Recent research suggests that the developmental processes of sexual differentiation might render women more susceptible than men to similar levels of immune or inflammatory burden by virtue of sex-specific differences in body composition and structure.
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