RESEARCH - Sex hormones and pregnancy in RA and lupus

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ls of the New York Academy of Sciences 876:131-144 (1999)

© 1999 New York Academy of Sciences

Sex Hormones and Pregnancy in Rheumatoid Arthritis and Systemic Lupus

Erythematosus

MONICA ØSTENSENa

Department of Rheumatology, University Hospital of Trondheim, N-7006

Trondheim, Norway

aTel: 47 73-868315; fax: 47 73-867698.

ABSTRACT: Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)

are autoimmune disorders with a preponderance in females. RA and SLE differ

in their response to sex hormones. Disease development of RA is mitigated by

estrogen and pregnancy whereas SLE tends to flare during pregnancy and in

response to estrogen. Pregnancy improves the symptoms of RA in about 75% of

pregnant patients, but relapses within six months postpartum in 90% of

cases. RA is regarded as a T cell-mediated and TH1 immune response-driven

disease. Pregnancy induces a shift from TH1 to TH2 immune response,

increasing the anti-inflammatory cytokines IL-4 and IL-10, which may

contribute to gestational amelioration of RA. Prospective studies of SLE

pregnancies indicate that about 50% of patients experience a flare, however,

with no permanent aggravation of the disease. Lupus nephritis, presence of

antiphospholipid antibodies, and a previous history of pregnancy loss

increase the risk of complications during pregnancy and fetal loss. The

marked increase of estrogen and progesterone during pregnancy seems to

enhance some of the manifestations of SLE. The shift to a TH2 immune

response may trigger SLE manifestations that are dependent on humoral immune

responses such as lupus nephritis. Another factor stimulating immune

responses is the pituitary hormone prolactin, which has been found elevated

in SLE patients of both sexes and correlated to disease activity in several

studies. The hyperprolactinemia of lactation seems to influence postpartum

behavior of SLE as well as RA.

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