Pregnancy may hold arthritis key

[Guest guest]

Pregnancy may hold arthritis key

By Jane Elliott

BBC News health reporter

For the whole of Liz Pringle's pregnancy and for a few months

afterwards her body was free from the pain which had haunted her for

years.

Even daily activities such as getting up from a chair or dressing

had become agony for Liz, who has rheumatoid arthritis (RA).

" Some times I could not even go down the stairs or put my underwear

on because I could not lift my shoulders.

" My hips were always hurting and even when I was opening the door I

felt as though my wrist was broken. "

" I was diagnosed with RA as I was training to be a nurse and every

day there was another ache or pain. I thought I was becoming a

hypochondriac. "

Rheumatoid arthritis

Affects more than 400,000 people in the UK

Causes inflammation of multiple joints, cartilage loss and bone

erosion, leading to joint destruction

Can affect other tissues, such as lungs, eyes and bone marrow

After ten years fewer than 50% of patients can work or function

normally on a day-to-day basis

But as soon as Liz, aged 32, from Leeds became pregnant the pain

stopped.

" I noticed immediately. I did not have any pain in my knees or hips.

" Before, even lying in bed I had felt bad. But now I found I could

run up steps and get up without stiffening up.

" I felt normal for the first time since I had been diagnosed and it

was heaven.

" It lasted for the whole of my pregnancy and for some time

afterwards, but about four months after the birth I had to stop

breast feeding because it had got too painful and I could not hold

my daughter, Olivia. "

Originally, Liz had been on anti-inflammatories and the drug

hydroxychloroquine to help ease her pain.

But when she started trying for a baby she came off the drugs and

went onto low-dose pain-killers and calcium.

New study

Nobody knows why women with RA go into remission during pregnancy,

but the Arthritis Research Campaign (ARC) is funding a two-year

project with more than £160,000 of funding to try to find out.

And although the work is still in its early stages, the scientists

working on it are hopeful that it will ultimately lead to new

hormonal treatments which can be used to control RA in patients.

The team is led by Dr Betz - an immunologist at the MRC

Laboratory of Molecular Biology in Cambridge - and Dr

Ehrenstein - a consultant rheumatologist at University College,

London.

Their team will be looking at special immune system cells which seem

to play a role in pregnancy-induced remission - the regulatory T

cells.

It is already known that female sex hormones play a large part in

easing RA during pregnancy, but it is not known why.

Women who take the drug HRT and the contraceptive pill also have

respite from their symptoms, but as soon as they stop taking them

their condition flares up again.

The scientists are now hoping to recruit about 15 women volunteers

with RA with a view to monitoring them through pregnancy and for

about a year after.

They will take blood samples from the women and see if they can

observe how the cells function.

Mimic the effect

Dr Ehrenstein is hopeful about the outcome of the research.

It seems that these cells, instead of activating the immune system,

actually dampen it down

Dr Betz

" It is almost universal that pregnant reheumatoid arthritis patients

do get better, " he said.

" If we understand how pregnancy makes the difference we have seen in

these cells and how it is doing what it is, then we can target the

pathway and mimic not the pregnancy, but the effect on the cells. "

However, Dr Ehrenstein said at this stage the mechanism underlying

the changes in the T cells is still unclear.

His colleague, Dr Betz said it had been shown that during pregnancy

the number of regulatory T cells expands substantially to prevent

the rejection of the foetus.

" The expansion of these regulatory T cells - which appears to be

driven by the elevated hormone levels caused by pregnancy - has a

beneficial effect on RA patients, and leads to an improvement in

symptoms.

" It seems that these cells, instead of activating the immune system,

actually dampen it down. "

Liz said a breakthrough would be good news for RA sufferers like

herself.

" I think it would be fantastic if this worked because you quickly

forget the pain when you are having a good day.

" People think this is an old people's disease and it must be so much

worse when you are older and can't get around as well. It has been

quite debilitating. "

A spokeswoman for ARC said it was hoped the research would bring

some practical benefits.

" We hope our research will have a direct practical benefit for women

with RA, by ultimately developing a hormone treatment to keep their

condition under more effective control. "

Dr Ehrenstein would like any pregnant RA patients who would like to

take part in his study to contact him on 0207 380 9281.

Story from BBC NEWS:

http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4236071.stm

Published: 2005/02/05 01:28:43 GMT

© BBC MMV