Abstract
BackgroundIncreasing awareness related to reproduction in rheumatic diseases to clarify the patho-physiology of immune/inflammatory diseases.Infertility is a heterogeneous condition related to immunological mechanisms, to pregnancy loss, to disease burden (Østensen et al 2014). Autoimmune problems as lupus, Crohn's disease, rheumatoid arthritis might lead to infertility in women (Clowse, 2012). The main types of immune problems in women with recurrent pregnancy loss: antithyroid antibodies, antiphospholipid antibodies, antinuclear antibodies and “Natural Killer Cells” (Ota et al 2014).ObjectivesTo detect the presence of natural Killer Cells (CD 57) in endometrial biopsy of Unexplained infertility having rheumatoid arthritis by immunohistochemistry, in comparison to normal casesMethodsThis is a case control studyon 2groups:A-Study group of 20 women with unexplained infertility & rheumatoid arthritis. B-Control group: of 20 fertile women age matched. All cases had antinuclear antibodies,Progesterone level in blood,Serum Prolactin,Thyroid stimulating hormone levels.Diagnostic laparoscopy was done for all cases to exclude pelvic cause for infertility. Endometrial biopsy was taken by D&C. The presence of natural Killer Cells was done by immunohistochemistry using antibody to CD 57.The results were interpreted according to scoring system from 0 to +3 (depending on number of cells per High Power field.ResultsThe age of the cases was 21 to 36 years, 66% had infertility more than 5 years, while 33% were less than 5 years. NK cell density was53% with NK cells 6-10/HPF, while 20% had NK cells >10.NK cell density among controls, was 35%, as 3-5 cells/HPF, 60% had no cells/HPF. NK cell density >10 was more in cases compared to controls with statistically significant difference. There was no correlation between Nk cell density versus age of the patient & duration of disease. The sensitivity of NK cells was 93.5%, the specificity was 60% & the accuracy was 70%.ConclusionsDetection of NK cell density in the endometrium of patients with rheumatoid arthritis & unexplained infertility is important. Increase in the NK cell density in patients could be one of the risk factors associated with pregnancy failure. We recommend interdisciplinary management of pregnancies among patients with rheumatoid disease for ensuring optimal pregnancy outcomesReferencesØstensen M, Andreoli L, Brucato A, Cetin I, Chambers C, Clowse M, Costedoat-Chalumeau N, Cutolo M, Dolhain R, Fenstad M, Förger F, Wahren-Herlenius M, Ruiz-Irastorza G, Koksvik H, Nelson-Piercy C, Shoenfeld Y, Tincani A, Villiger PM, Wallenius M, von Wolff M. State of the art: Reproduction and pregnancy in rheumatic diseases. Autoimmun Rev. 2014 Dec 30.Clowse ME, Chakravarty E, Costenbader KH, Chambers C, Michaud K. Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2012 May;64(5):668-74. doi: 10.1002/acr.21593.Ota K, Dambaeva S, Lee J, Gilman-Sachs A, Beaman K, Kwak-Kim J. Persistent high levels of IgM antiphospholipid antibodies in a patient with recurrent pregnancy losses and rheumatoid arthritis. Am J Reprod Immunol. 2014 Mar;71(3):286-92.Disclosure of InterestNone declared