Can miscarriage and rheumatism also be related?

Introduction: Rheumatic immunological diseases are closely related
to fertility.
If 2 or more consecutive spontaneous abortions cannot be found, you may be able to go to the rheumatology and immunology department to rule out whether it is an immune problem
.
Here's a brief look at a few common rheumatic immune diseases
that can cause recurrent miscarriages.

Antiphospholipid syndrome

Antiphospholipid syndrome is a relatively common autoimmune disorder characterized clinically by recurrent arterial or venous thrombosis, recurrent miscarriage and/or thrombocytopenia, and persistent positivity of antiphospholipid antibodies (mainly medium- to high-titer anticardiolipin antibodies and lupus anticoagulants
).
It is generally divided into two categories
: primary and secondary.
Primary refers to those for which no clear cause can be found, and secondary is often secondary to systemic lupus erythematosus or other autoimmune diseases
.

The idea that antiphospholipid syndrome is the cause of recurrent miscarriage is also well
established.
Many studies have shown that antiphospholipid antibodies can cause placental microthrombosis, resulting in insufficient blood supply to the placenta, and fetal loss due to placental dysfunction, such as recurrent spontaneous abortion in the first trimester and stillbirth in the third
trimester.
According to statistics, the abortion rate of patients with positive antiphospholipid antibodies with systemic lupus erythematosus can be as high as 28.
6%, and the abortion rate of patients with simple antiphospholipid syndrome is 10%~15%.

Undifferentiated connective tissue disease

Undifferentiated connective tissue diseases are a heterogeneous group of systemic autoimmune disorders that present with the presence of at least one sign or symptom of connective tissue disease with abnormal autoantibody tests, but does not meet the diagnostic criteria
for any other connective tissue disease.
About one-third of undifferentiated connective tissue diseases will differentiate into specific connective tissue diseases after months or years, such as systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome, and Sjogren's syndrome, but most undifferentiated connective tissue diseases will maintain low mobility for a long time or even do not progress
for life.

The effects of undifferentiated connective tissue disease on pregnancy and fetus are clear, including miscarriage, eclampsia, fetal growth retardation, preterm birth, congenital heart block, neonatal lupus, etc
.
A case-control study of 41 pregnant women with undifferentiated connective tissue disease reported by Spinill et al.
showed that patients with undifferentiated connective tissue disease were more likely to have recurrent miscarriage, with an incidence of about 9.
5%, compared with only 1.
2% in the normal control group (P=0.
0004), that is, recurrent miscarriage is a common and important clinical manifestation
in patients with undifferentiated connective tissue disease.
At the same time, pregnancy can aggravate the condition of undifferentiated connective tissue disease and accelerate its differentiation into connective tissue disease
.

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that occurs mainly in women
of reproductive age.
The disease generally does not affect the fertility of patients, but it has a greater
impact on the fetus.
Disease conditions, autoantibodies such as anticardiolipin antibodies, and drug use may all be associated with
adverse pregnancy outcomes.

According to statistics, the miscarriage rate of pregnant women with systemic lupus erythematosus is 14.
8% ~ 21.
7%.

Studies have shown that patients in the active preconception group are at higher risk of miscarriage than those in the group with complete remission or largely stable, suggesting that choosing the right timing of pregnancy is one of
the keys to good pregnancy outcomes in patients with lupus.

Sjogren's syndrome

Pregnancy outcomes in patients with Sjogren syndrome are currently reported to be limited
.
Reports of 117 cases of pregnancy complicated with Sjogren's syndrome in 1 group abroad show that although simple primary Sjogren's syndrome does not increase the risk of miscarriage and intrauterine growth restriction, if patients with Sjogren's syndrome have serological abnormalities (positive antiphospholipid antibodies, anti-red blood cell antibodies, lupus anticoagulants, etc.
) and hematologic abnormalities (thrombocytopenia, erythrocytopenia), or secondary Sjogren syndrome combined with systemic lupus erythematosus, they significantly affect pregnancy and increase the incidence
of spontaneous abortion, preterm birth and birth of small gestational-age infants 。 In China, Li Li et al.
have shown that the incidence of miscarriage in pregnant patients with Sjogren's syndrome is significantly higher than that in healthy control groups, and anti-SSA antibodies are associated with spontaneous abortion, but the sample size of the study is not large
.

Rheumatoid arthritis

The relationship between rheumatoid arthritis and miscarriage is still controversial, and some people believe that women with rheumatoid arthritis have a higher
miscarriage rate.
Prospective cohort studies by Brouwer et al.
found that 28 of the 162 pregnant women with rheumatoid arthritis had miscarriages, and within 1 year of miscarriage, most rheumatoid arthritis patients who continued to conceive became pregnant and had a live birth; The miscarriage rate in patients with rheumatoid arthritis is 17%, which is similar
to the clinically recognized cumulative risk of pregnancy of 11%~20%.
In contrast, Wallenius et al.
, in reviewing the risk of miscarriage in 1578 women with rheumatoid arthritis, found that the relative risk of early and late miscarriage in pregnant women with rheumatoid arthritis was 1.
2 and 1.
4, respectively, and concluded that the risk of miscarriage in women with rheumatoid arthritis was slightly higher than the reference value
。 A 2019 retrospective study by Nathan et al.
of 3 276 127 pregnant rheumatoid arthritis patients found that among women under 35 years of age, women with rheumatoid arthritis had a 25% higher risk of miscarriage compared with women without rheumatoid arthritis; There was no difference
in the risk of miscarriage after age 35.
Many conditions, such as irregular medication during pregnancy or progression of disease activity, can lead to miscarriage
.
Whether the miscarriage rate of women with rheumatoid arthritis is increased still needs to be determined by large clinical studies
.

Tips

Patients with autoimmune diseases should not worry too much, having an impact does not mean that you cannot get pregnant
.
However, it is important to have a planned pregnancy, and strict contraception
is necessary if not prepared.
Under the guidance of specialists in obstetrics and rheumatology, do a good job of preconception assessment, choose the appropriate treatment drugs, and then choose the appropriate pregnancy time on the basis of controlling the disease activities, and strengthen pregnancy monitoring, which can prevent the occurrence of
unexpected events such as recurrence, miscarriage, premature birth, and thrombosis.