Abstract
Objective: The aim of the work was to describe the characteristics of married rheumatoid arthritis (RA) female patients with history of spontaneous abortion and compare them to those without. Patients and methods: Three hundred and four female RA with history of abortion compared with another 304 RA married patients of matched age without history of abortion. Patients were subjected to full history taking and clinical examination. The routine laboratory investigations were done in addition to rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), antinuclear antibody. Also, plain x-ray hands were performed to detect erosions. Disease activity score (DAS28) and health assessment questionnaire (HAQ) were assessed. Results: In this study 3.5 % of patients with history of abortion out of a large RA cohort (n = 8750), had a mean age of 42.8±11.4 years and disease duration of 6.2 ±5.4 years. 14 (4.6 %) were smokers. There was a significant increase in the frequency of metabolic syndrome in those with abortion (17.4%) than in those without (10.9%) (p=0.008). Methotrexate (MTX) and hydroxychloroquine (HCQ) were less frequently used among patients with a history of spontaneous abortion (67.8% and 68.8%) compared to those without (82.6% and 78%) (p =0.005 and p =0.037 respectively). Disease activity and the functional status were comparable between those with and without abortion. Conclusion: Spontaneous abortion in RA females was higher in those with metabolic syndrome. Reluctance and/or incompliance in using the basic DMARD treatment with MTX or HCQ in controlling the disease may add to the possibility of abortion.
References
- Hadinedoushan H, Aflatounian A, Anvari M. The Role of IL-2 and rheumatoid factor in recurrent spontaneous abortion. Biochemia Medica.2008;18(2):201-5
- Kvien TK, Uhlig T, Ødegård S, Heiberg MS. Epidemiological aspects of rheumatoid arthritis: the sex ratio. Ann NY Acad Sci 2006;1069: 212-22.
- Cavalcante AFDS, Martin P, Skare TL. Gynecological/obstetric background and rheumatoid arthritis: A cross-sectional study in Brazilian patients. Rev Bras Ginecol Obstet. 2021;43(5):357-61.
- Chakravarty EF. Rheumatoid arthritis and pregnancy: beyond smaller and preterm babies. Arthritis Rheum. 2011;63: 1469–71.
- Brouwer J,Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: influence of disease activity and medication. Ann Rheum Dis. 2014;74(10):1836-41.
- Nørgaard M, Larsson H, Pedersen L, et al. Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Intern Med. 2010; 268: 329–37.
- Gheita TA, Raafat HA, El-Bakry SA, Elsaman A, El-Saadany HM, Egyptian College of Rheumatology (ECR) Rheumatoid Arthritis Study Group. Rheumatoid arthritis study of the Egyptian College of Rheumatology (ECR): Nationwide presentation and worldwide stance. Rheumatol Int. 2022; epub ahead of print.
- Delabaere A, Huchon C, Deffieux X, Beucher G, Gallot V, Nedellec S, et al. Epidemiology of loss pregnancy. J Gynecol Obstet Biol Reprod 2014;43:764–75.
- Wallenius M, Salvesen KÅ, Daltveit AK, Skomsvoll JF. Miscarriage and Stillbirth in Women with Rheumatoid Arthritis. J Rheumatol. 2015;42(9):1570-2.
- Reed SD, Vollan TA, Svec MA. Pregnancy outcomes in women with rheumatoid arthritis in Washington State. Matern Child Health J 2006;10:361–6.
- 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 2012;64:668–74.
- Smolen JS. Treat-to-target: rationale and strategies. Clin Exp Rheumatol 2012;30 Suppl 73:S2–6.
- Giacomucci E, Bulletti C, Polli V, Prefetto RA, Flamigni C. Immunologically mediated abortion (IMA). J Steroid Biochem Mol Biol. 1994;49(2-3):107-21
- Wallenius M, Salvesen KA, Daltveit AK, Skomsvoll JF. Increased rates of spontaneous abortions, but not stillbirths in rheumatoid arthritis. Ann Rheum Dis 2013;72 Suppl 3:A761–2.
- Nathan NO, Mørch LS, Wu CS, Olsen J, Hetland ML, Li J, Rom AL. Rheumatoid arthritis and risk of spontaneous abortion: a Danish nationwide cohort study. Rheumatology (Oxford). 2020;59(8):1984-91.
- The Lancet Rheumatology. Editorial: The demise of Roe v Wade: ramifications for rheumatology. The Lancet Rheumatology. 2022;4(8):e525.
- Al Rayes H, Sultana A, Alotaibi AM, Alaithan MA, Attar M, Daghasi H, et al. Adverse Impact of Rheumatoid Arthritis on Pregnancy Outcomes: A Saudi Arabia Prospective Multicenter Study. Research and Reviews 2021(13):167–75.
- Chang MK, Lee CH, Park JS, Lim HS, Lee J. Incidence and prevalence of seropositive rheumatoid arthritis among Korean women of childbearing age:a nationwide population-based study. KJIM 2022; epub ahead of print
- Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham 3rd CO, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62(9):2569-81.
- Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38(1):44-8.
- Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23(2):137-45
- National cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults; Third report of the national cholesterol education program expert panel (NCEP) on detection, evaluation and treatment of high blood choleaterol in adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.
- Smith JB, Cowchock FS, Hankinson B, Iftekhar A. Association of HLA-DR5 with recurrent spontaneous abortion in women treated with paternal leukocytes. Possible subclinical autoimmune disease. Arthritis Rheum. 1989;32(12):1572-6.
- Kuśnierczyk P. Killer cell immunoglobulin-like receptor gene associations with autoimmune and allergic diseases, recurrent spontaneous abortion, and neoplasms. Front Immunol. 2013;4:8.
- Sattar MA, al-Saffar M, Guindi RT, Sugathan TN, Behbehani K. Association between HLA-DR antigens and rheumatoid arthritis in Arabs. Ann Rheum Dis. 1990;49(3):147-9.
- Fattah A, Asadi A, Shayesteh MRH, Hesari FH, Jamalzehi S, Abbasi M, et al. Fertility and infertility implications in rheumatoid arthritis; state of the art. Inflamm Res. 2020;69(8):721-9.
- Cieslinski JZ, Goeldner I, Skare TL, Nisihara R, Andrade FA, Velavan TP, Messias-Reason I, Utiyama SRR. Mannose-binding lectin deficiency and miscarriages in rheumatoid arthritis. Autoimmunity. 2017;50(7):409-413
- Xu B, Zhang J, Xu Y, Lu J, Xu M, Chen Y, et al. Association between history of abortion and metabolic syndrome in middle-aged and elderly Chinese women. Front Med. 2013;7(1):132-7.
- Napier ADL. The Relationship between Neuralgia and Abortion: A Clinico-Speculative Note. Trans EdinbObstet Soc. 1889; 14:37-44.
- Iijima T, Tada H, Hidaka Y, Mitsuda N, Murata Y, Amino N. Effects of autoantibodies on the course of pregnancy and fetal growth. Obstet-Gynecol 1997;90(3):364-9.
- Chaiamnuay S, Bridges SL Jr. The role of B cells and autoantibodies in rheumatoid arthritis: Pathophysiology 2005;12(3):203-16.
- Ota K, Dambaeva S, Lee J, Gilman-Sachs A, Beaman K, Kwak-Kim J. Persistent high levels of IgM antiphospholipid antibodies in a patient with recurrent pregnancy losses and rheumatoid arthritis. Am J Reprod Immunol. 2014;71(3):286-92
- Gheita TA, Eesa NN. Rheumatology in Egypt: back to the future. Rheumatol Int. 2019;39(1):1-12
- ACR subcommittee on RA guidelines. Guidelines for the management of rheumatoid arthritis 2002 updates. Arthr Rheum 2002;46(2): 328-46.
- Pasquier E, de Saint-Martin L, Marhic G, Chauleur C, Bohec C, Bretelle F et al. Hydroxychloroquine for prevention of recurrent miscarriage: study protocol for a multicentre randomised placebo-controlled trial BBQ study. BMJ Open 2019;9:e025649
- Murray KE, Moore L, O’Brien C, Clohessy A, Brophy C, Minnock P, et al. Updated pharmacological management of rheumatoid arthritis for women before, during, and after pregnancy, reflecting recent guidelines. Ir J Med Sci. 2019;188:169–72.
- Østensen M, Andreoli L, Brucato A, Cetin I, Chambers C, Clowse ME, et al. State of the art: reproduction and pregnancy in rheumatic diseases. Autoimmun Rev. 2015;14:376–86.
- Bortoluzzi A, Andreoli L, Carrara G, Ramoni V, Rumi F, Padovan M, et al. Improved Pregnancy Outcome in Patients With Rheumatoid Arthritis Who Followed an Ideal Clinical Pathway. Arthritis Care Res (Hoboken). 2021;73(2):166-72.
- Silman A, Roman E, Beral V, Brown A. Adverse reproductive outcomes in women who subsequently develop rheumatoid arthritis. Ann Rheum Dis. 1988;47:979.
- Spector TD, Silman A. Is poor pregnancy outcome a risk factor in rheumatoid arthritis? Ann Rheum Dis. 1990;49:12.
- Nørgård BM, Larsen MD, Friedman S, Knudsen T, Fedder J. Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study. Ann Rheum Dis. 2019;78:328–34.
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