Endocrine Abstracts

Introduction: Pregnancy is characterized by increased secretion of estrogens and cortisol. Estrogen is used to prepare the maternal environment for the fetus. Cortisol induces a state of immunosuppression to avoid loss of the fetus, which, by definition, is at least partly a foreign organism. Parturition is characterized by estrogen and cortisol withdrawal. It leads to a rebound in immunity and may be accompanied by the development of autoimmune disease. Autoimmune thyroid disease is observed postpartum and may be related to this rebound in immunity. Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease.

Aim: The aim was to present the cases of two female patients who developed RA postpartum after the birth of their second child.

Methods: The cases of two female patients aged 40 and 42 years, respectively, who developed RA postpartum after the birth of their second child are described.

Results: The patients went into menopause immediately following the birth of their second child. RA was RF(+) anti-CCP antibody (+) and led into hospitalization of the patients for a month following parturition. Corticosteroids were administered followed by methotrexate. In long-term follow up both patients required the addition of a biologic agent and are now in remission on treatment with methotrexate and a biologic agent at the age of 79 and 81 years, respectively.

Conclusions: Oestrogen and cortisol withdrawal may have led to the development of RA immediately postpartum in the cases described herein. The development of RA postpartum has been previously reported. Amongst a large cohort of RA patients 2 were reported to develop RA postpartum. RA flare has also been reported postpartum. Additionally, autoimmune thyroid disease is known to occur postpartum, an incidence, which may also be related to steroid hormone withdrawal. In conclusion, estrogen and cortisol withdrawal may reverse the immunologically beneficial maternal profile and may lead to the development of postpartum clinical autoimmune disease.