Gerfaud-Valentin M, Hot A, Huissoud C, Durieu I, Broussolle C, Seve P
Department of Internal Medicine, Croix Rousse University Hospital, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France,
Rheumatol Int. 2014 Jun;34(6):867-71. doi: 10.1007/s00296-013-2765-5. Epub 2013 Apr 27.
Little is known about the interactions between adult-onset Still's disease (AOSD) and pregnancy. In an attempt to clarify the link between these 2 conditions, we retrospectively analyzed patients registered as suffering from AOSD seen in our university hospital. A total of 57 patients, among them 30 women, were diagnosed. Ten pregnancies in 8 women were identified. Three cases manifested AOSD in their first trimester, all treated with prednisone. Premature births and flares occurred in 2 patients. One patient developed a monocyclic AOSD during her second pregnancy's postpartum. In the 4 other cases, AOSD was known and quiescent before pregnancy. One patient had 2 pregnancies without any flare or complication. One patient experienced her first pregnancy while under treatment and presented a late flare 8 months after delivery. The third patient developed exacerbation in the first trimester of her second pregnancy which was treated with IgIV alone. The last one presented her first pregnancy 7 years after diagnosis. A prednisone-treated systemic flare occurred during the first trimester without later complication. Based on our own experience and the analysis of only two series of the literature, including, respectively, 4 and 5 patients, we suggest that two settings could be distinguished. First, AOSD can occur during pregnancy and can be responsible for obstetrical complications. Then, in patients with known AOSD, the second trimester and postpartum appear to be periods exposing to disease recurrence. Thus, we recommend a close multidisciplinary monitoring by a rheumatologist and an obstetrician prior to, during and after pregnancies.
关于成人斯蒂尔病（AOSD）与妊娠之间的相互作用，人们了解甚少。为了阐明这两种情况之间的联系，我们对在我校医院就诊并登记为患有AOSD的患者进行了回顾性分析。共诊断出57例患者，其中30例为女性。确定了8名女性的10次妊娠情况。3例在孕早期出现AOSD，均接受泼尼松治疗。2例患者出现早产和病情复发。1例患者在第二次妊娠产后发生单循环型AOSD。在其他4例中，AOSD在妊娠前已知且处于静止期。1例患者经历2次妊娠，未出现任何病情复发或并发症。1例患者在治疗期间经历首次妊娠，产后8个月出现晚期病情复发。第3例患者在第二次妊娠的孕早期病情加重，仅接受静脉注射免疫球蛋白（IgIV）治疗。最后1例患者在诊断7年后经历首次妊娠。孕早期出现经泼尼松治疗的全身性病情复发，随后未出现并发症。基于我们自己的经验以及仅对两份文献系列（分别包括4例和5例患者）的分析，我们建议可以区分两种情况。首先，AOSD可在妊娠期间发生，并可能导致产科并发症。其次，在已知患有AOSD的患者中，孕中期和产后似乎是疾病复发的时期。因此，我们建议在妊娠前、妊娠期间和产后由风湿病学家和产科医生进行密切的多学科监测。
