Is rheumatism related to estrogen and progesterone disorders? What should women with rheumatism pay attention to when they are pregnant?

Author: Su Yin, Chief Physician, Peking University People's Hospital

Reviewer: Zhang Zhuoli, Chief Physician, Peking University First Hospital

Rheumatism is a group of diseases that mainly affect joints, bones, muscles, blood vessels and related soft tissues or connective tissues. Most of them are autoimmune diseases. There are two main categories: diffuse rheumatic disease and rheumatic disease with joint and muscle damage as the main cause.

Typical representatives of diffuse rheumatic diseases include systemic lupus erythematosus, Sjögren's syndrome, systemic sclerosis, etc. Rheumatic diseases mainly affecting joint muscles include rheumatoid arthritis, ankylosing spondylitis, gouty arthritis, etc.

Diffuse rheumatic disease often affects women of childbearing age, which is related to the disorder of female estrogen and progesterone. For example, in the early stages of pregnancy or before and after delivery, the estrogen and progesterone levels in the body change significantly, which may aggravate or induce rheumatic disease.

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What symptoms should alert you to rheumatism during pregnancy? Oral ulcers recur, occur multiple times or do not heal for a long time; joint pain and swelling last for more than two weeks; unexplained fever or intermittent fever, generally low-to-moderate fever, and sometimes high fever lasting for more than two weeks; obvious hair loss; skin allergies after sun exposure, with rashes and large patches of red spots; the tips of fingers turn white when exposed to cold, and turn purple after one or two minutes; dry mouth and eyes, which do not improve for a long time, etc. Pay special attention to the above conditions during pregnancy, and go to the rheumatology department in time for treatment. The doctor will determine whether it is rheumatism, what kind of rheumatism it is, and whether medication is needed.

The impact of rheumatism on pregnancy is on the mother on the one hand, and on the fetus on the other. The main factor affecting the fetus is the medication, which is of great concern to everyone. If you get rheumatism during pregnancy, it may have a serious impact on the mother if you do not take medication. You may need to terminate the pregnancy and then receive treatment. If the mother's condition allows and she is particularly eager to have this child, the doctor may choose medication that has less impact on the fetus to control the condition, but if the condition cannot be controlled, the pregnancy will also need to be terminated.

Although rheumatic disease has a certain impact on pregnancy, women with rheumatic disease can get pregnant, provided that the disease is under complete control, that is, in complete remission. If the disease is still active, pregnancy will have a great impact on the mother and may even be life-threatening. For example, women with systemic sclerosis, renal damage, renal crisis, and women with severe pulmonary hypertension complications may be in danger of death in the late pregnancy.

Some drugs for treating rheumatism have an impact on the fetus, such as thalidomide, formerly known as thalidomide, which was first used to treat vomiting in pregnant women. Later, it was found that pregnant women who took this drug gave birth to children with short limbs, called seal fetuses, so this drug was once discontinued. Now it is found that this drug can treat rheumatism, but if the patient wants to get pregnant, it must be stopped in advance, and it must be stopped for at least 3-6 months before making pregnancy plans to avoid fetal malformations.

In addition, if the condition of rheumatism is unstable, such as antiphospholipid antibodies in the body, it will induce small blood clots in the placenta, resulting in poor blood supply to the fetus, intrauterine fetal death or placental detachment, etc., which usually occurs in the first three months of pregnancy. If the condition is not well controlled in the late pregnancy, it will also lead to many complications, such as premature birth, fetal distress, and malignant hypertension, threatening the mother and fetus.

Women with rheumatic diseases are advised to consider pregnancy after their condition has stabilized for at least half a year, and should plan their pregnancy after the doctor has assessed and confirmed that it is safe, which can reduce the chance of complications. There have been many successful cases of giving birth to healthy babies.

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Women with rheumatism may stop taking rheumatism medications before or during pregnancy. Stopping medications will definitely have an impact on rheumatism. It is not recommended to stop all medications. Under the guidance of a doctor, some medications that are harmful to the fetus should be stopped according to the condition of the disease. Do not stop taking medications blindly in order to have a child, which is not good for the condition or the child.

In 2020, the international community issued expert consensus and guidelines on the use of medications for patients with rheumatic diseases during pregnancy. It is believed that some drugs have very little effect on the fetus, such as glucocorticoids. Most of them do not cross the placenta, and small doses have no effect on the fetus.

In addition, women with rheumatic disease must visit the rheumatology department for regular checkups during pregnancy, especially in the first three months of pregnancy. They may need to have a checkup every month. During the stable period, they can have a checkup every three months, mainly to see if there are any fluctuations in the condition and whether the medication is appropriate.

After childbirth, the levels of estrogen and progesterone in the body change greatly, so how to control the disease from recurring also requires special attention. It is recommended to go to the rheumatology department for a comprehensive disease assessment within one month after delivery. If the condition is stable, there is no need to adjust the medication; if the condition worsens, the treatment plan should be adjusted in time. Some drugs can be used during breastfeeding, and the doctor will provide specific medication guidance.