Miscarriage Associated With Progressive Joint Disease in Rheumatoid
Arthritis

By Will Boggs, MD

NEW YORK (Reuters Health) Jul 20 - A history of miscarriage before the
onset of rheumatoid arthritis (RA) is associated with progressive
joint disease in women with the disease, according to a report in the
August Annals of the Rheumatic Diseases.

"Once a patient presents with RA it would be helpful to predict the
amount of joint destruction over time and to establish whether that
patient will need more aggressive treatment," Dr. Frederique M. van
Dunne from Leiden University Medical Center, The Netherlands told
Reuters Health. "Past reproductive history could be one of the factors
which will assist in distinguishing the more severe RA from the less
severe at first visit."

Dr. van Dunne and colleagues investigated whether a less favorable
reproductive outcome was associated with more severe rheumatoid
arthritis by studying the reproductive history and rate of joint
destruction of 113 women with newly diagnosed rheumatoid arthritis.

The time to pregnancy (fecundity) showed no association with the
progression of joint damage over the 24-month study. In contrast, the
authors report, a history of at least one miscarriage was associated
with a significant increase in joint destruction, even after
adjustment for other prognostic factors.

Despite slight differences in baseline disease activity score and
C-reactive protein concentrations between women with and without
miscarriages, the researchers note, both outcomes were similar at the
end of two years.

"Our results could indicate that the phenotype of joint destruction is
associated with the phenotype of reported miscarriages, suggesting
that there are common genetic risk factors for each of these two
traits, possibly acting through the innate Th1/Th2 phenotype," the
investigators conclude.

"Further studies are being done on progressive joint destruction," Dr.
van Dunne said. "Extensive research is being done on pregnancy and the
Th1/Th2 balance, and we are in the process of writing up a study on
Th1/Th2 cytokines and pregnancy in the general population."

Ann Rheum Dis 2004;63:956-960.

Visit my website:
http://www.mzuschlag.com