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Schenone C, Pacini G, Gotelli E, Hysa E, Campitiello R, Sammorì S, Paolino S, Sulli A, Cutolo M. Updating on pregnancy in rheumatoid arthritis. Expert Rev Clin Immunol 2024:1-12. [PMID: 38748553 DOI: 10.1080/1744666x.2024.2356164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Rheumatoid arthritis (RA), the most prevalent autoimmune disease in reproductive years, exhibits a higher incidence in females, suggesting involvement of estrogens, genetics and environmental factors in disease onset. Literature shows smaller families in RA patients, driving increased interest in Assisted Reproductive Techniques. AREAS COVERED This review elucidates how immunotolerance mechanisms contribute to favorable pregnancy outcomes in RA, emphasizing the need for a careful pregnancy planning to mitigate fetal complications and postnatal flares, which surpass those in the general population. A thorough medication evaluation, orchestrated by a multidisciplinary team, is imperative during pregnancy, weighing potential teratogenic effects against safer alternatives to balance medication safety with disease control. A systematic literature search on PubMed and MEDLINE, using specific terms, covered relevant academic journals up to the latest date. EXPERT OPINION This narrative review comprehensively addresses pregnancy-related considerations in RA patients, prioritizing meticulous disease management with pregnancy and breastfeeding-compatible drugs in line with the latest recommendations and registry data. The focus remains on evaluating glucocorticoids, conventional, and biological disease-modifying drugs for compatibility during pregnancy and breastfeeding. Additionally, the evolving landscape of targeted synthetic drugs during pregnancy is explored, providing insights into the latest developments in rheumatological care.
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Affiliation(s)
- Carlotta Schenone
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Greta Pacini
- Rheumatology Unit, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Rosanna Campitiello
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Silvia Sammorì
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Andreoli L, Guadagni I, Picarelli G, Principi M. Comprehensive reproductive healthcare for women with immune-mediated inflammatory diseases: Addressing rheumatoid arthritis, spondyloarthritis and inflammatory bowel disease through life's stages. Autoimmun Rev 2024; 23:103507. [PMID: 38142899 DOI: 10.1016/j.autrev.2023.103507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
Immuno-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis, spondyloarthritis, and inflammatory bowel disease are characterised by pathophysiological mechanisms wherein the immune system erroneously targets the body's own tissues. This review explores the heightened vulnerability of women with IMIDs, influenced by hormonal modulators like estrogen and progesterone. The challenges this poses are multifaceted, encompassing the impact of active disease and medical treatments throughout life stages, including family planning, fertility, and menopause. From the perspectives of rheumatologists and gastroenterologists, we review current management strategies and underscore the need for a multidisciplinary and life-cycle approach to healthcare for women with IMIDs.
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Affiliation(s)
- Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | | | | | - Mariabeatrice Principi
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
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Jiang LQ, Zhang RD, Musonye HA, Zhao HY, He YS, Zhao CN, He T, Tian T, Gao ZX, Fang Y, Wang P, Ni J, Pan HF. Hormonal and reproductive factors in relation to the risk of rheumatoid arthritis in women: a prospective cohort study with 223 526 participants. RMD Open 2024; 10:e003338. [PMID: 38195516 PMCID: PMC10826586 DOI: 10.1136/rmdopen-2023-003338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/11/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE This study aimed to examine rheumatoid arthritis (RA) risk associated with hormonal and reproductive factors in women from the large cohort of the UK Biobank. METHODS Data on hormonal and reproductive factors in women were collected from a prospective cohort of 223 526 UK Biobank participants. The potential relationship between reproductive factors and RA risk was assessed using restricted cubic spline. Hazard ratios (HR) were estimated using Cox proportional hazard regressions. RESULTS During a median follow-up of 12.39 years, 3313 women with RA were identified. Age at menarche >14 years was associated with a greater RA risk (HR 1.13, 95% CI 1.02 to 1.26) compared with menarche at 13. The multiple adjusted HR for RA in women with menopause at <45 years was 1.46. Reproductive years <33 increased the risk of RA (HR 1.39, 95% CI 1.21 to 1.59). Compared with those with 2 children, women with ≥4 children were associated with a higher risk of RA (HR 1.18, 95% CI 1.04 to 1.34). Women who had a hysterectomy (HR 1.40, 95% CI 1.25 to 1.56) or oophorectomy (HR 1.21, 95% CI 1.08 to 1.35) had a higher risk of RA than those without a hysterectomy or oophorectomy. Both hormone replacement therapy (HRT) use (HR 1.46, 95% CI 1.35 to 1.57) and HRT duration (HR 1.02, 95% CI 1.01 to 1.03) were associated with a higher risk of RA. CONCLUSIONS Some hormonal and reproductive factors were associated with a higher risk of RA. Hormonal and reproductive factors should be considered in risk assessment and formulating management plans in female patients with RA.
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Affiliation(s)
- Ling-Qiong Jiang
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruo-Di Zhang
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Harry Asena Musonye
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hao-Yun Zhao
- Department of Clinical Medicine, Anhui Medical University, Hefei, China
| | - Yi-Sheng He
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chan-Na Zhao
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tian He
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tian Tian
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
| | - Zhao-Xing Gao
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yang Fang
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Peng Wang
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Hefei, China
| | - Jing Ni
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, Anhui Medical University School of Public Health, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation & Immunity Mediated Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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