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Biomedical subjects

M Ostensen

Publications and source records attributed to M Ostensen.

At least 19 recordsLinked to original sources
PubMed2006

[Antirheumatic therapy and reproduction. The influence on fertility, pregnancy and breast feeding].

Antirheumatic drugs can have a negative effect on reproduction in both men and women. Possible negative effects are impairment of fertility, harmful effects on the fetus and adverse effects on the breastfed child. In women non-steroidal antiinflammatory drugs (NSAID) and cyclophosphamide can impair fertility. In men infertility can result from the use of salazopyrine and cyclophosphamide. A desire for children should be taken into account before the start of disease modifying drugs (DMARD). Treatment with NSAID is possible at some stages of pregnancy as well as during lactation. A limited number of DMARD is compatible with pregnancy and is presented. Cytostatic drugs and leflunomide must be prophylactically withdrawn before a planned pregnancy. TNF alpha antagonists should be discontinued at the start of pregnancy. Safe birth control must be practised during therapy with drugs that are gonadotoxic or teratogenic. Treatment with immunosuppressive drugs during lactation is limited because of insufficient documentation of safety for the breastfed child.

Abnormalities, Drug-Induced↗
PubMed2006

[Pregnancy in patients with rheumatoid arthritis and inflammatory spondylarthropathies].

The activity of a rheumatic disease can be influenced by pregnancy and puerperium. Prospective studies have shown an improvement in joint involvement in rheumatoid arthritis in two thirds to three quarters of pregnancies. After birth, an exacerbation is common. In spondylarthropathies there is no relevant change in disease activity. The fetal outcome is not impaired in patients with rheumatoid arthritis and inflammatory spondylarthropathies. Every pregnancy in women with a rheumatic disease should be considered as high-risk, and such pregnancies require close collaboration between rheumatologists and obstetricians.

Antirheumatic Agents↗
PubMed2005

Reproduction and gynaecological manifestations in women with primary Sjögren's syndrome: a case-control study.

BACKGROUND: The impact of primary Sjögren's syndrome (pSS) on reproduction and gynaecological manifestations has seldom been explored. AIM OF STUDY: Assess gynaecological aspects, gynaecological interventions, and use of contraceptives in a population of pSS-patients versus controls. METHODS: In a case-control study, 58 pSS-patients and 157 controls answered a self-administered questionnaire, covering demographic data, reproductive events, gynaecological problems, and gynaecological interventions. RESULTS: Significantly more patients than controls reported episodes of amenorrhoea lasting for more than 3 months, and more patients suffered from menorrhagia/metrorrhagia compared with controls (54.5% versus 35.7%; p = 0.012). Complaints of vaginal dryness were common among the patients (52.9% versus 28.3%; p = 0.005). Endometriosis was reported to occur more frequently in the patients (8.5% versus 2.1%; p = 0.03), and 6.3% of pSS-patients reported having undergone surgical intervention for endometriosis versus 0.7% of the controls (p = 0.009). Positive information about surgery for endometriosis correlated with the presence of the autoantibodies anti-SSA (r = 0.322; p = 0.008) and anti-SSB (r = 0.313; p = 0.01). Among the pSS-patients, 5.9% had chosen not to have children due to the disease, but there was no indication of reduced fertility as judged by the number of pregnancies. CONCLUSION: Patients with pSS reported more gynaecological problems than controls, including vaginal sicca symptoms, endometriosis, several episodes of amenorrhoea, and menorrhagia/metrorrhagia.

Adult↗
PubMed2004

Disease specific problems related to drug therapy in pregnancy.

Rheumatic diseases occur frequently in women of childbearing years necessitating drug treatment also during a concurrent pregnancy in order to control maternal disease activity and to ensure a successful pregnancy outcome. This survey reviews maternal and fetal side effects of nonsteroidal anti-inflammatory drugs (NSAID) and immunosuppressive agents in pregnant patients. The classic nonselective nonsteroidal anti-inflammatory drugs are not teratogenic, but given in late pregnancy they can induce renal and cardiac side effects in the fetus. Similar effects must be expected of the new, selective Cox2-inhibitors. NSAID should therefore be stopped by gestational week 32. Corticosteroids are frequently necessary to control rheumatic disease flares and for prevention of serious organ manifestations. However, due to an increased risk of oral clefts, high doses (1-2 mg/kg) should be avoided in the first trimester. Among disease modifying drugs, sulfasalazine and antimalarials have the safest record. Cyclosporine and azathioprine can be given throughout pregnancy if disease control requires it. Insufficient data exist for treatment of pregnant patients with TNF-inhibitors and mycophenolate mofetil. The severity of the disease under treatment decides if continuation of one of these drugs is justified. Prophylactic withdrawal of drugs before pregnancy is mandatory for leflunomide and the cytotoxic agents methotrexate and cyclophosphamide. Prepregnancy counselling and careful monitoring during pregnancy help to tailor necessary drug treatment for the benefit of mother and child.

Abnormalities, Drug-Induced↗
PubMed2001

Elevated levels of osteoprotegerin (OPG) and hepatocyte growth factor (HGF) in rheumatoid arthritis.

Rheumatic diseases are often associated with changes in bone metabolism. Excessive production and release of cytokines and other growth factors due to inflammation, e.g. tumor necrosis factor-alpha (TNF-alpha), receptor activator of NF-kappaB ligand (RANKL), interleukins such as IL-1 and IL-6, may cause alterations in bone homeostasis leading to bone degradation. Other components such as osteoprotegerin (OPG) and possibly the ligand-receptor pair hepatocyte growth factor (HGF) and c-met may counteract this destruction, we have measured the levels of OPG, and HGF c-met, in serum, synovial fluid (SF), and cartilage from patients with rheumatoid arthritis (RA) and other arthritides. We found a) elevated levels of both OPG and HGF in SF from RA patients relative to arthritides of other causes, b) increased levels of both OPG and HGF in SF from seropositive RA patients (RA+) compared to seronegative RA patients (RA-), c) elevated levels or both OPG and HGF in serum from RA patients compared to healthy controls, d) no correlation between severity of inflammation and levels of OPG or HGF, and e) presence of HGF c-met in both cartilage and synovial tissue. The most significant elevations of OPG and HGF were found in patients with RA, the rheumatic disease most frequently associated with the development of secondary osteoporosis.

Adult↗
PubMed2001

Number of births, interpregnancy interval, and subsequent pregnancy rate after a diagnosis of inflammatory rheumatic disease in Norwegian women.

OBJECTIVE: To study female reproduction, i.e., number of births, subsequent pregnancy rate, and interpregnancy interval after diagnosis of inflammatory rheumatic disease. METHODS: In a national population based cohort study, reproduction in mothers with rheumatic disease, registered with the Medical Birth Registry of Norway 1967-1995, were compared to mothers without such diagnoses. RESULTS: After diagnosis, women with rheumatic disease had a statistically significant lower mean number of births, a shorter time span of reproduction, longer interpregnancy intervals, and a reduced subsequent pregnancy rate. CONCLUSION: Altered reproduction observed in women with a rheumatic disease might reflect various mechanisms not accounted for in this study, but possibly related to the disease process, functional impairment, or medical treatment.

Adult↗
PubMed2000

Reproduction in women reporting chronic musculoskeletal disorders.

UNLABELLED: The present population based study assessed aspects of female health as a part of a national cardiovascular screening program in 40-42 year old women in the Sor-Trondelag county. Fertility, events related to the menstrual cycle, reproduction, and the use of contraceptive methods in women reporting musculoskeletal diseases (MSD) were compared to women without these disorders (references). A higher proportion of women with MSD reported subfertility. No significant difference in mean age of menarche or menstrual cycling pattern was found, however women reporting MSD had significantly more often metrorrhagia than references. Mother's age at birth of the first and last child differed from references only in two of the patient groups, and interval between pregnancies was longer in women with MSD. Women with MSD more often chose sterilisation as a contraceptive method. CONCLUSION: Reproduction was altered in women with MSD. It remains to elucidate the interrelationship between rheumatic disorders and gynecological dysfunction.

Adult↗
PubMed2000

Nonsteroidal anti-inflammatory drugs in systemic lupus erythematosus.

Up to 80% of patients with systemic lupus erythematosus (SLE) are treated with nonsteroidal anti-inflammatory drugs (NSAID) for musculoskeletal symptoms, serositis and headache. This survey reviews the literature on non-selective and selective inhibitors of cyclooxygenases, with an emphasis on the efficacy and safety profile reported in SLE patients. No lupus-specific data on gastro-intestinal side effects of NSAID exist. Both non-selective Cox inhibitors and selective Cox-2 inhibitors induce renal side effects, including sodium retention and reduction of the glomerular filtration rate. Lupus nephritis is a risk factor for NSAID-induced acute renal failure, but not for rare idiosyncratic toxic renal reactions to NSAID. In refractory nephrotic syndrome, NSAID have been used successfully. Cutaneous and allergic reactions to NSAID are increased in SLE patients as well as hepatotoxic effects, particularly with high dose aspirin. Whereas a variety of central nervous system side effects of NSAID are probably no more common in SLE patients than others, aseptic meningitis has been reported more frequently. Ovulation and pregnancy can be adversely affected by Cox inhibitors. The antiplatelet effect of aspirin and non-selective Cox inhibitors has a therapeutic potential in patients with antiphospholipid syndrome (APS). In summary, treatment of SLE with NSAID requires awareness for the increased frequency of some side effects and close monitoring of toxicity.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Pregnancy complications and delivery practice in women with connective tissue disease and inflammatory rheumatic disease in Norway.

OBJECTIVE: To assess possible associations between inflammatory rheumatic disease and pregnancy complications/delivery practice. METHODS: In a population based study proportions were compared of obstetrical complications and interventions at delivery notified to the Medical Birth Registry of Norway during the years 1967-95 in women with (3,403) and without (671,221) rheumatic disease. RESULTS: Women with rheumatic disease had significantly higher rates of preeclampsia and cesarean section. The relative risk of preeclampsia was particularly high in women with connective tissue disease in the years 1977-86. In women with inflammatory arthritides, the relative risk of preeclampsia was particularly high during 1987-95. The relative risk of cesarean section was high in all patient groups throughout the observation period and particularly in women with connective tissue disease. CONCLUSION: High rates of preeclampsia and cesarean section in connective tissue disease pregnancies documented in a population based study emphasize the importance of monitoring and obstetrical interventions.

Adult↗
PubMed2000

Sex, reproduction, and gynecological disease in young adults with a history of juvenile chronic arthritis.

OBJECTIVE: To study the effect of chronic disease of childhood on aspects of reproduction in young adults with a history of juvenile chronic arthritis (JCA). METHODS: Demographic data, clinical features of JCA, previous medical treatment, reproductive events, contraception, wish for children, sexuality, and gynecological disease were evaluated by means of a questionnaire in 126 women and 35 men with JCA and their age matched healthy counterparts. RESULTS: Median age of patients and controls was 24 years. Median age at menarche was 13 years in female patients and controls. Female patients who shared characteristics of marital status with their healthy counterparts showed a similar attitude to sexual activity, contraception, wish for children, age at first child, and duration of lactation. Fertility was not impaired in JCA, but fecundity was significantly reduced. Also, pregnancy outcome was less successful in women with JCA, shown by a significantly increased rate of miscarriage. When analyzing the occurrence of gynecological disease, a higher proportion of patients had metrorrhagia, pelvic inflammatory disease, and surgery for ovarian cysts. Males with JCA had greater difficulties than both healthy males and female patients in establishing a permanent relationship to the opposite sex. CONCLUSION: Our study shows that a history of JCA in young men and women can influence several aspects of reproductive behavior and health. Health care providers counseling adolescents with JCA need to be aware of these problems.

Adolescent↗
PubMed2000

Low dose weekly methotrexate in early pregnancy. A case series and review of the literature.

OBJECTIVE: To assess the teratogenic risk of low dose weekly pulses of methotrexate (MTX) inadvertently taken during the first trimester of pregnancy. METHODS: We assessed pregnancy and neonatal outcome of 4 patients with rheumatic disease treated with weekly pulses of 5 to 15 mg of MTX for a mean duration of 4 years. RESULTS: The 4 patients had continued MTX treatment from one to 6 weeks of gestation. One patient miscarried at Week 6, the other pregnancies ended with the delivery of healthy children. Chromosome analysis of one child was normal. CONCLUSION: In spite of the absence of congenital anomalies in our cases, safe contraception in fertile patients who start low dose weekly MTX is mandatory.

Abnormalities, Drug-Induced↗
PubMed2000

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 increases as pregnancy progresses. A flare of RA is observed within 6 months after delivery in most patients. Originally believed to be due to the increase of cortisol during pregnancy, three studies of the 1950-60s did not find a correlation between cortisol levels and disease activity in pregnant patients. Also the timing of gestational improvement and the postpartum flare does not coincide with the rise and fall of cortisol levels. New research has disclosed neuroendocrine disturbances in RA including a relative glucocorticoid deficiency. The complex hormonal and immunological alterations of pregnancy may temporarily correct the neuroendocrine defects. The precise role of glucocorticoids in pregnancy-induced remission of RA still needs to be clarified.

Arthritis, Rheumatoid↗
PubMed1999

[Polychondritis--a rare and difficult diagnosis].

We present two patients with polychondritis. Polychondritis is a rare inflammatory disease of unknown origin, but immunological mechanisms are essential in the pathogenesis. Histological features are inflammation and destruction of cartilage. The disease is systemic, may have a remitting course, and it can be primary or associated with several other diseases. We also review the literature with emphasis on symptoms, clinical presentation, diagnostic procedures and treatment. The literature consists mainly of case reports, summary of case reports, no epidemiological and only few clinical studies. Two sets of diagnostic criteria with great similarities have been proposed. Non-steroidal antiinflammatory drugs or immunosuppressive drugs like glucocorticoids and cyclophosphamide are the drugs of choice, depending on the stage and severity of the disease.

Adolescent↗
PubMed1999

Sex hormones and pregnancy in rheumatoid arthritis and systemic lupus erythematosus.

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are autoimmune disorders with a preponderance in females. RA and SLE differ in their response to sex hormones. Disease development of RA is mitigated by estrogen and pregnancy whereas SLE tends to flare during pregnancy and in response to estrogen. Pregnancy improves the symptoms of RA in about 75% of pregnant patients, but relapses within six months postpartum in 90% of cases. RA is regarded as a T cell-mediated and TH1 immune response-driven disease. Pregnancy induces a shift from TH1 to TH2 immune response, increasing the anti-inflammatory cytokines IL-4 and IL-10, which may contribute to gestational amelioration of RA. Prospective studies of SLE pregnancies indicate that about 50% of patients experience a flare, however, with no permanent aggravation of the disease. Lupus nephritis, presence of antiphospholipid antibodies, and a previous history of pregnancy loss increase the risk of complications during pregnancy and fetal loss. The marked increase of estrogen and progesterone during pregnancy seems to enhance some of the manifestations of SLE. The shift to a TH2 immune response may trigger SLE manifestations that are dependent on humoral immune responses such as lupus nephritis. Another factor stimulating immune responses is the pituitary hormone prolactin, which has been found elevated in SLE patients of both sexes and correlated to disease activity in several studies. The hyperprolactinemia of lactation seems to influence postpartum behavior of SLE as well as RA.

Animals↗
PubMed1999

[Rheumatoid arthritis and heart disease].

Rheumatoid arthritis is a chronic inflammatory disease that usually involves the joints, tendons and bursae. The disease is systemic and may involve the brain, peripheral nerves, lungs, kidneys, heart and blood-vessels. All anatomical structures of the heart may be involved. Most reports on rheumatoid arthritis and heart disease are case reports and autopsy studies. Sonography studies from recent years show pathology in some heart structures at about the same rate as autopsy studies. Mortality studies from the last ten years provide evidence of increased cardiovascular mortality. The frequency of reported rheumatoid heart disease differs according to the method applied in the studies. Clinically significant disease is infrequent. We describe two cases with pericarditis and give a review of the literature.

Aged↗
PubMed1999

Perinatal outcome in pregnancies of women with connective tissue disease and inflammatory rheumatic disease in Norway.

Perinatal outcome in infants of women with rheumatic disease notified between 1967 95 to the Medical Birth Registry of Norway was compared to women without such disease. Logistic regression provided odds ratios for associations between rheumatic disease and perinatal outcome for 3 time periods: 1967-76, 1977-86, and 1987-95. Women with rheumatic disease had significantly higher rates of preterm birth than references and this was only partly correlated to the increased occurrence of preeclampsia. The risk of small for gestational age (SGA) infants was significantly higher both in women with connective tissue disease (CTD) and inflammatory arthritides. The proportion of infants with Apgar score < = 6 after 1 minute and 5 minutes was significantly increased in the CTD group indicating moderate to severe fetal asfyxia. The rate of perinatal mortality was high in the CTD group and postperinatal mortality was increased in infants born to mothers with rheumatic disease. Thus, rheumatic disease not only comprises pregnancy outcome, but increases the risk of adverse perinatal outcome.

Apgar Score↗
PubMed1998

Spondyloarthritides in females.

Few studies have been performed regarding clinical, radiological and prognostic features of females with spondyloarthropathies other than ankylosing spondylitis (AS). In AS, clinical manifestations appear similar in men and women, whereas radiological features appear more frequent and severe in males. However, no consistent differences in outcome and mortality between men and women have been disclosed. Although fetal outcome is not compromised in women with spondyloarthropathy (SpA), the interaction of pregnancy and SpA has been studied in detail only in AS. Spinal disease is unchanged while peripheral arthritis and uveitis are suppressed during childbearing. Due to possible maternal and fetal side-effects, NSAIDs must be discontinued during the last 8 weeks of pregnancy, but during lactation several NSAIDs can be used. Treatment with sulphasalazine is compatible with pregnancy and lactation. Children of AS patients exhibit a slightly increased risk of developing SpA later in life.

Adult↗