Pregnancy and Rheumatic Diseases

M. Gayed; C. Gordon

Disclosures

Rheumatology. 2007;46(11):1634-1640. 

In This Article

Vasculitides

In contrast to RA and SLE, the vasculitides are commoner in men then women and tend to occur in an older age group, so they rarely complicate pregnancy. The data that exists is mostly from small case series in contrast to the cohort studies available for RA, SLE and even systemic sclerosis. Takayasu's disease is the most commonly seen vasculitis in pregnancy, excluding idiopathic vasculitis and the vasculitis of SLE, and it is associated with hypertension, congestive heart failure and renal failure. Takayasu's disease has also been complicated in pregnancy by pre-eclampsia, antepartum haemorrhage, stroke (thrombosis and bleed) and sepsis.[14] Proteinuria and haematuria usually indicate renal involvement, whereas hypertension followed by proteinuria usually indicates pre-eclampsia, similar to the situation in SLE.

In women with Beçhet's disease there is an increased risk of thrombosis due to both the disease process and pregnancy itself. Despite anticoagulation central venous thrombosis may occur and in these cases IV heparin should be initiated. Wegner's granulomatosis may present prior, during or after pregnancy in women of child bearing age.[45] The commonest time for flares is in the first or second trimester or postpartum. Steroids and azathioprine should be used to control disease. Cyclophosphamide is much more toxic and not usually recommended in pregnancy but flares of Wegner's granulomatosis have been successfully treated with cyclophosphamide during the third trimester of pregnancy. Polyarteritis nodosa (PAN) can occur during pregnancy or in the postpartum period and is associated with a high mortality. Churg–Strauss vasculitis is associated with flares in pregnancy and during the postpartum period.[45]

With all vasculitides it is important to ensure that the disease is inactive prior to pregnancy as it has been observed that there is an increased risk of maternal and fetal mortality in pregnancies where newly diagnosed active or uncontrolled vasculitis is present.[45] It is important to distinguish pre-eclampsia from renal vasculitis. Proteinuria and haematuria is association with other features of vasculitis usually indicates active disease, whereas hypertension followed by proteinuria usually indicates pre-eclampsia similar to the situation in SLE.

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