Rheumatoid Arthritis and Reproduction

Golding, Amit; Haque, Uzma; Giles, Jon T.

doi:10.1016/j.rdc.2007.01.001

Cited by 44 publications

(31 citation statements)

References 93 publications

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“…The preterm delivery rate in this cohort (19% of live births) was found to be higher than the general population (10%-12%) 18 but may be similar to rates reported in women with certain chronic medical conditions. 19,20 Two congenital malformations (2.2%) were reported, a rate consistent with what is seen in the general obstetric population. 21 No pattern of congenital anomalies was identified to be associated with rituximab exposure.…”

Section: Discussionsupporting

confidence: 81%

Pregnancy outcomes after maternal exposure to rituximab

Chakravarty

Murray²,

Kelman³

et al. 2011

Blood

484

321

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Rituximab is a chimeric anti-CD20 monoclonal B cell-depleting antibody indicated for certain hematologic malignancies and active rheumatoid arthritis with inadequate response to tumor necrosis factor antagonists. Despite counseling to avoid pregnancy, women may inadvertently become pregnant during or after rituximab treatment. Using the rituximab global drug safety database, we identified 231 pregnancies associated with maternal rituximab exposure. Maternal indications included lymphoma, autoimmune cytopenias, and other autoimmune diseases. Most cases were confounded by concomitant use of potentially teratogenic medications and severe underlying disease. Of 153 pregnancies with known outcomes, 90 resulted in live births. Twenty-two infants were born prematurely; with one neonatal death at 6 weeks. Eleven neonates had hematologic abnormalities; none had corresponding infections. Four neonatal infections were reported (fever, bronchiolitis, cytomegalovirus hepatitis, and chorioamnionitis). Two congenital malformations were identified: clubfoot in one twin, and cardiac malformation in a singleton birth. One maternal death from pre-existing autoimmune thrombocytopenia occurred. Although few congenital malformations or neonatal infections were seen among exposed neonates, women should continue to be counseled to avoid pregnancy for < 12 months after rituximab exposure; however, inadvertent pregnancy does occasionally occur. Practitioners are encouraged to report complete information to regulatory authorities for all pregnancies with suspected or known exposure to rituximab. (Blood. 2011;117(5):1499-1506)

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Section: Discussionsupporting

confidence: 81%

Pregnancy outcomes after maternal exposure to rituximab

Chakravarty

Murray²,

Kelman³

et al. 2011

Blood

484

321

View full text Add to dashboard Cite

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“…24 Dr Hench believed that corticosteroids were substance X, 25 but subsequent studies have not supported this claim. 6 One hypothesis tested in this work was whether an ES-62-like molecule existed that might represent substance X. …”

Section: Discussionmentioning

confidence: 98%

“…21 The original observation that pregnancy improves the signs and the symptoms of about 70-80% of pregnant women with rheumatoid arthritis (RA) was reported by Phillip Hench in 1938 , 22 and was believed to be due to some substance X. 6,23 This observation contributed eventually to the discovery of corticosteroids and for which the Nobel Prize in Medicine in 1950 was awarded to Drs. Edward Kendall and Phillip Hench and Tadeus Reichstein.…”

Section: Discussionmentioning

confidence: 99%

“…There have been several other reports confirming that the majority of women with RA do experience disease amelioration during pregnancy. 6 One report demonstrated the ameliorating effect of a postpartum autologous plasma transfusion in a patient with rheumatoid arthritis. 24 Dr Hench believed that corticosteroids were substance X, 25 but subsequent studies have not supported this claim.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] However the mechanism of action by which this phenomenon occurs is unclear. 6 The Th1/Th2 hypothesis by Wegmann proposed that normal pregnancy induced a bias toward Th2 cytokine production. 7 Such a cytokine bias would reduce RA activity since RA is predominantly a Th1 driven disease.…”

Section: Introductionmentioning

confidence: 99%

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Searching for a placental derived ES-62-like molecule to explain rheumatoid arthritis amelioration in pregnancy

Scoville¹,

Rasmussen

2014

Rheumatol Rep

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The majority of women with rheumatoid arthritis (RA) experience disease amelioration during pregnancy for unclear reasons. One possible explanation pursued and described here is whether the placenta produces a protein similar to the immunomodulating protein, ES-62, excreted by filarial nematodes. This protein has also been shown to reduce disease activity in animal models of RA. Eleven human placentas were prepared and a polyclonal anti-ES-62 antiserum was used to identify if any ES-62-like molecule exists from human placental tissues. Any bands identified were then excised from the gel and sent for mass spectrometry and protein identification. The antiserum showed consistent cross reactivity with the heavy chain from immunoglobulin G (IgG) from the eleven human placentas by mass spectrometry. No primary sequence homology between the heavy chain of IgG and ES-62 was identified. The placenta does not produce an ES-62-like molecule. However the binding of the antiserum to the Fc region of IgG suggests that this may be a possible mechanism for rheumatoid factor production in some patients with chronic filarial infections.

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Rheumatoid arthritis and pregnancy: Beyond smaller and preterm babies

Chakravarty¹

2011

Arthritis & Rheumatism

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Rheumatoid Arthritis and Reproduction

Cited by 44 publications

References 93 publications

Pregnancy outcomes after maternal exposure to rituximab

Pregnancy outcomes after maternal exposure to rituximab

Searching for a placental derived ES-62-like molecule to explain rheumatoid arthritis amelioration in pregnancy

Rheumatoid arthritis and pregnancy: Beyond smaller and preterm babies

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