Seems like I remember see a discussion on this subject in the recent past but not sure that these facts were brought up, any way if so here it is again......................LEV
When Denise Swanson developed rheumatoid arthritis nearly three decades ago, it was like a sudden storm of pain, swelling and fatigue.
It was excruciating for the then-21-year-old college student just to pick up her backpack. She couldn't even write. Medication eased her pain and stiffness, but not much.
"I would move like an old lady," said Swanson, now a 49-year-old special-education teacher in Seattle. "It was scary."
But then a few years later Swanson and her husband, Tom, did something that happened to bring total relief from the devastating disease: They decided to have a baby. All of Swanson's symptoms disappeared about a month after she became pregnant.
"With all the things you're supposed to cope with in pregnancy, this was a joy," Swanson said. "I really did well. I felt like [my arthritis] had gone away forever."
Scientists — and many new mothers — have long known that pregnancy relieves rheumatoid arthritis. What hasn't been entirely clear is why.
Now researchers at Seattle's Fred Hutchinson Cancer Research Center have delved deeper toward an answer, for the first time identifying that DNA from dead cells naturally sloughing off the growing fetuses probably results in the pregnant women getting relief from their arthritis.
"The bottom line is we could see a specific effect on the arthritis," said Dr. Lee Nelson, an expert on pregnancy and immunology, and leader of the recent study reported in the journal Arthritis & Rheumatism.
"If we can understand this better, we could possibly work toward specific treatments for autoimmune diseases."
DNA
The Fred Hutchinson scientists looked at the amount of DNA from the fetus circulating in the blood of 25 pregnant women with arthritis and found that the fetal DNA was plentiful in the blood of almost all the women. Those with higher DNA levels had significant relief from the disease. Four who had little or no relief had low levels of the DNA.
Then, about two to four months after delivery, almost all the women with arthritis relief experienced a return of the painful disease.
Pregnancy has also been known to relieve the symptoms of multiple sclerosis and Graves' disease, a thyroid disorder, both of which also are autoimmune diseases.
The Hutchinson scientists speculate that the fetal DNA acts as a sort of decoy: The mother's immune system focuses on the fetal DNA instead of the mother's synovial membrane cells. Immune cells decide the fetal DNA is OK, so they back off their attack on the mother's joints.
Fetal DNA is technically "foreign" to the body, but the immune cells are programmed not to attack DNA from cells that have died as the result of a natural process, rather than from infection or another cause, said Drs. Kristina Adams and Zhen Yan, other researchers on the study.
Swanson found arthritis relief through three pregnancies. But after each delivery — with Graham, now 20; Isaac, now 17; and Chris, now 12 — her arthritis returned after about two months. When participating in the Hutchinson study with her last two pregnancies, the researchers found the measured fetal DNA levels dropped soon after delivery, and her hands were soon too stiff to manipulate diaper pins or even hold her baby to nurse.
"I would get stiff and more and more uncomfortable," Swanson said.
Swanson's medications for arthritis have ranged from aspirin and several other anti-inflammatory drugs, to shots of gold, which acts more broadly on the immune system. The medications have controlled her arthritis fairly well, but she has suffered side effects, including mouth sores, stomach problems, raised blood pressure and weight gain.
1 percent
About 1 percent of the population has rheumatoid arthritis or juvenile arthritis, and women are more than twice as likely to have it as men, experts estimate. The diseases can be debilitating, eventually deforming joints and making walking and using the hands very difficult.
Women with the disease are more likely to deliver prematurely or by Caesarean section and may have longer hospitalizations, other recent research has indicated. A drug that would better target the basic autoimmune process of rheumatoid arthritis would be welcomed by millions of patients like Swanson, Nelson said.
Nelson and her colleagues are the first to examine the role of fetal DNA in arthritis remission during pregnancy. Other scientists have investigated how the genetics of the fetus and biochemicals that regulate the immune system influence arthritis.
Next, the Hutchinson scientists hope to expand the study to examine the activity of immune cells and look more closely at fetal proteins that may help trigger the immune system's response.
Nelson predicts that a medication could be developed in about five years, depending on drug-company interest.
This latest research was financed by the National Institutes of Health and the Washington Women's Foundation, which awards grants for work in health, social services, arts and culture, education and the environment.
That is how I had an inkling I was preggo with my son... most RA symptoms disappeared and I did not have a need for celebrex... all symptoms were managble.
Thanks for the article, i always like to see hope. Maybe one day they will fix this and i won't have to worry about my daughter getting it.Lev, I'm printing this off and taking it with me to my next Rheum appt. I had a hysterectomy in 2002. I have polysystic ovaries (which they left in). Every so often I get PMT (you know big rock hard boobs, fluid retention), when I get these symptoms I am totally pain free. I lay in bed and listen to a body thats normally yelling in pain and hear nothing.
| Rheumatoid arthritis and pregnancy |
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| Bonnie L Bermas, MD UpToDate performs a continuous review of over 375 journals and other resources. Updates are added as important new information is published. The literature review for version 15.3 is current through September 2007; this topic was last changed on September 20, 2007. The next version of UpToDate (16.1) will be released in March 2008. INTRODUCTION — Rheumatoid arthritis (RA) affects 1 to 2 percent of the adult population in the United States. There is a female predominance in RA, and many female patients are of childbearing age [1]. Thus, the management of RA during pregnancy is a common challenge. In many patients with RA, disease activity improves substantially in the gravid state. However, modification of treatment so as to minimize the potential for fetal toxicity while maintaining adequate disease control can be difficult in patients whose RA flares or remains active. IMMUNOLOGY OF PREGNANCY — Many immunologic changes must occur during pregnancy in order to maintain the viability of the fetus. Immunologic alterations occur at the maternal-fetal interface to prevent "rejection" of the fetus [2]. Among these are changes in cytokine secretion from a Th1 predominance to a Th2 predominance [3], an estrogen-induced increase in the synthesis of complement components by the liver, diminished activity of natural killer cells, increases in soluble tumor necrosis factor alpha (TNF) receptors, and increases serum plasma levels of interleukin-1 receptor antagonist [4-7]. Increased binding of circulating TNF and antagonism of interleukin-1 (IL-1) may contribute to the symptomatic improvement of RA symptoms in some women during pregnancy. In one study, improvement of RA symptoms during pregnancy correlated with greater HLA mismatch in one study [8]. This effect could be mediated by antibodies against HLA class II antigens or the induction of suppressor mechanisms. However, this correlation with HLA mismatches has not been observed in all reports [9]. HORMONES AND RHEUMATOID ARTHRITIS — The increased incidence of RA in women suggests that sex hormones might have an influence on RA. As an example, women have noted improved symptoms during the luteal phase of the menstrual cycle, the time when the production of gonadal steroids, particularly progesterone, is maximal [10]. In addition, oophorectomized female mice demonstrate a heightened susceptibility to collagen-induced arthritis [11]. Pregnancy related changes in circulating hormones may contribute to a shift to a less inflammatory state during pregnancy. Both premenopausal and postmenopausal women with RA appear to have lower serum levels of adrenal androgens (eg, dehydroepiandrosterone [DHEA]) [12,13]. DHEA, cortisol, estrogen, progesterone, and norepinephrine, all of which are elevated in pregnancy, contribute to the Th2 dominant cytokine profile that emerges in pregnancy [14]. (See "Immunology of pregnancy" above). |