Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, CH-3010 Bern, Switzerland.
Rheumatology (Oxford). 2011 Apr;50(4):657-64. doi: 10.1093/rheumatology/keq350. Epub 2010 Nov 18.
Despite evidence for the important role of oestrogens in the aetiology and pathophysiology of chronic immune/inflammatory diseases, the previous view of an unequivocal beneficial effect of oestrogens on RA compared with a detrimental effect on SLE has to be reconsidered. Likewise, the long-held belief that RA remits in the majority of pregnant patients has been challenged, and shows that only half of the patients experience significant improvement when objective disease activity measurements are applied. Pregnancies in patients with SLE are mostly successful when well planned and monitored interdisciplinarily, whereas a small proportion of women with APS still have adverse pregnancy outcomes in spite of the standard treatment. New prospective studies indicate better outcomes for pregnancies in women with rare diseases such as SSc and vasculitis. Fertility problems are not uncommon in patients with rheumatic disease and need to be considered in both genders. Necessary therapy, shortly before or during the pregnancy, demands taking into account the health of both mother and fetus. Long-term effects of drugs on offspring exposed in utero or during lactation is a new area under study as well as late effects of maternal rheumatic disease on children.
尽管雌激素在慢性免疫/炎症性疾病的病因和病理生理学中具有重要作用，但以前认为雌激素对类风湿关节炎有益，而对系统性红斑狼疮有害的观点必须重新考虑。同样，以前认为大多数怀孕的类风湿关节炎患者会缓解的观点也受到了挑战，这表明只有一半的患者在应用客观疾病活动测量时会有显著改善。如果经过良好的计划和跨学科监测，系统性红斑狼疮患者的妊娠大多是成功的，而尽管进行了标准治疗，一小部分抗磷脂综合征患者仍会出现不良妊娠结局。新的前瞻性研究表明，患有硬皮病和血管炎等罕见疾病的女性的妊娠结局更好。风湿性疾病患者的生育问题并不罕见，无论男女都需要考虑。在怀孕前或怀孕期间进行必要的治疗时，需要考虑母亲和胎儿的健康。药物对宫内或哺乳期暴露的后代的长期影响以及母体风湿性疾病对儿童的迟发影响也是正在研究的新领域。
