COLLAGEN VASCULAR DISEASES

Rheumatoid diseases are disorders characterized by widespread or localized inflammation of the con-nective tissue. Inflammation mainly occurs due to degenerative, autoimmune, or metabolic changes in the connective tissue. The collagen tissue is one of the widest tissues in the human body and provides support between all the other tissues and organs. Even a localized disturbance occurring in these tis-sues may progress and lead to multisystemic effects. The diseases are more commonly seen in women compared to men, and especially the autoimmune ones are more commonly observed in reproduc-tive-aged women. Additionally, the immunological and hormonal alterations of pregnancy may cause poorer obstetric outcomes affecting both maternal and fetal conditions. The multisystem autoimmune diseases in pregnancy can be demonstrated with wide spectrum manifestations including musculo-skeletal, neural, hematological, dermatological, cardiopulmonary, and urinary system. Rheumatolo-gists and obstetricians should manage in collaboration with a multidisciplinary approach, but even if there is teamwork, managing can be challenging. Mainly systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome, scleroderma, Sjögren syndrome, some vasculitis like Takayasu arteritis, ANCA-associated vasculitis, Behcet’s disease, polyarteritis nodosa, and myositis are seen during pregnancy and will be discussed in this chapter. The less systematic diseases like rheumatoid arthritis or spondyloarthritis, which are mostly seen with joint involvement, have fewer complications related to pregnancy, while systemic lupus erythematosus, antiphospholipid syndrome, and vasculitis have higher complications. Abortion, preterm delivery, fetal growth restriction, low birth weight and preeclampsia are more commonly seen in pregnancies with rheumatoid diseases. Pre-conceptional consultation is very important to assess the severity of diseases and ceasing the medications which are not suitable for pregnancy like methotrexate, leflunomide, mycophenolic acid, cyclophosphamide, Angiotensin Converting Enzyme inhibitors and Angiotensin II Receptor Blockers. A multidisciplinary approach especially together with obstetrician, rheumatologist and if necessary hematologist and ne-phrologist with close maternal and neonatal monitoring is necessary to optimize both maternal and fetal outcomes. Following well understanding of the nature of rheumatoid diseases during pregnancy, better outcomes and managements are going to be seen in the future.