Glucocorticosteroids in pregnant patients with rheumatoid arthritis

The ameliorating effect of pregnancy on rheumatoid arthritis (RA) has been well known since 1938 and repeatedly confirmed for 75 % of RA pregnancies. Improvement of symptoms usually occurs already in the first trimester and i ncreases as pregnancy progresses. A flare of RA is observed within 6 months after delivery in most patients. Originally believed to be due to the incr ease of cortisol during pregnancy, three studies of the 1950-60s did not fi nd a correlation between cortisol levels and disease activity in pregnant p atients. Also the timing of gestational improvement and the postpartum flar e does not coincide with the rise and fall of cortisol levels. New research has disclosed neuroendocrine disturbances in RA including a relative gluco corticoid deficiency. The complex hormonal and immunological alterations of pregnancy may temporarily corner the neuroendocrine defects. The precise r ole of glucocorticoids in pregnancy-induced remission of RA still needs to be clarified.