PREGNANCY AND PREMATURE BIRTH IN A PATIENT WITH RHEUMATOID ARTHRITIS
Keywords:
rheumatoid arthritis, premature, preterm delivery, pathologic pregnancy, arthritisAbstract
Rheumatoid arthritis (RA) is an autoimmune systemic disorder that can affect any organ or system of the human body, targeting predominantly females and at reproductive age. The disease shows variations in the clinical course and overall, it is characterized by joint pain, swelling and tenderness, symmetrical joint damage. Extra-articular involvement such as reduced cognitive function; inflammation and fibrosis of lungs; secondary Sjogren’s syndrome; sarcopenia; osteoporosis, etc, may be present.
Diagnosis of rheumatoid arthritis is made based on the American College of Rheumatology (ACR) and European League Against Rheumatism criteria which includes joints distribution, serology, symptom duration and acute phase reactants. During pregnancy RA flares are uncommon and primary diagnosis of rheumatoid arthritis is extremely rare. Women with high disease severity are more likely to experience adverse pregnancy outcomes including preterm labor. World Health Organization (WHO) defines preterm delivery as baby born alive occurring before completed 37 weeks of gestation and is further divided to: moderate to late preterm - 32-37 gestational weeks; very preterm – from 28 to less than 32 weeks and extremely preterm – less than 28 gestational weeks.
A clinical case of 35 year-old-woman with rheumatoid arthritis and human papillomavirus infection is presented with contractions upon admission. She was previously hospitalized twice at the department of rheumatology due to RA flares. Her cervical length was shortened and had no effect on pain syndrome until admission. Immunochromatographic test was performed which became positive for placental alpha microglobulin-1. Her uterine contractions were inhibited using tocolytics and corticosteroid prophylaxis of RDS was given. Seven days later a live fetus was born after tocolytic treatment in 34 weeks of gestation with fetal weight 2400g and 46 cm body length.
Pregnant women with autoimmune arthritis have a higher percentage of preterm births, more frequent spontaneous abortions and a lower percentage of live births. Timely diagnosis of high-risk pregnancy, including cervicometry with transvaginal sonography and vaginal examination, rapid immunochromatographic tests, as well as refinement of tocolytic therapy allows to achieve successful delivery of a viable fetus as close to term as possible.
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