Pregnancy in a patient with ankylosing spondylitis (Bechterew’s disease): a difficult differential diagnosis of preeclampsia
Ignatko I.V., Akhmedova A.E., Timokhina E.V., Sarakhova D.Kh., Samoylova Yu.A., Mishina N.A., Seurko K.I., Lazarev A.R., Marchukova L.I., Samara A.B.
Background: Ankylosing spondylitis (AS) is a chronic inflammatory condition that affects the spine and sacroiliac joints. It often occurs in women of reproductive age. The impact of AS on pregnancy has been the subject of much debate: a number of studies have indicated a correlation between AS and an elevated risk of preeclampsia, preterm labor and other complications, while other studies do not support this association.
Case report: A pregnant woman with AS who discontinued taking certolizumab at 20 weeks’ gestation was diagnosed with preeclampsia, fetal growth retardation, and nephrotic syndrome with marked proteinuria and hypoalbuminemia at 24–25 weeks’ gestation. However, the patient did not undergo renal replacement therapy and renal biopsy due to preserved renal nitrogen excretion function. The absence of effect of the multicomponent therapy resulted in the decision on the necessity of delivery at 28–29 weeks. After delivery, the patient resumed therapy with certolizumab and laboratory findings became normal.
Conclusion: Pregnancy in women with AS can be complicated by amyloidosis which has symptoms similar to preeclampsia. Pregnancy in patients without preeclampsia can last longer, but preeclampsia requires an early delivery. The sudden cessation of AS therapy had a negative impact on the course of the disease and the development of preeclampsia. It is important to continue therapy during pregnancy to reduce the risk of complications. The management of these patients requires a multidisciplinary approach.
Authors’ contributions: Ignatko I.V., Akhmedova A.E. – developing the concept and design of the study; Akhmedova A.E., Samoylova Yu.A., Mishina N.A. – collecting and processing the material; Lazarev A.R., Marchukov L.I. – statistical data processing; Akhmedova A.E., Seurko K.I., Samara A.B. – writing the text; Ignatko I.V., Timokhina E.V., Sarakhova D.Kh. – editing the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia.
Patient Consent for Publication: The patient signed informed consent for the publication of her data.
For citation: Ignatko I.V., Akhmedova A.E., Timokhina E.V., Sarakhova D.Kh., Samoylova Yu.A., Mishina N.A., Seurko K.I., Lazarev A.R., Marchukova L.I., Samara A.B. Pregnancy in a patient with ankylosing spondylitis (Bechterew’s disease): a difficult differential diagnosis of preeclampsia.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (6): 172-177 (in Russian)
https://dx.doi.org/10.18565/aig.2025.68
Keywords
nephrotic syndrome
AA amyloidosis
preeclampsia
ankylosing spondylitis
pregnancy
TNF-α inhibitors
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Received 11.03.2025
Accepted 21.05.2025
About the Authors
Irina V. Ignatko, Dr. Med. Sci., Corresponding Member of the Russian Academy of Sciences, Professor of the Russian Academy of Sciences, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University,Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, ignatko_i_v@staff.sechenov.ru, https://orcid.org/0000-0002-9945-3848
Aida E. Akhmedova, obstetrician-gynecologist, S.S. Yudin City Clinical Hospital, 115446, Russia, Moscow, Kolomensky Proezd, 4, +7(916)622-97-55,
aida.akhmedova1@gmail.com, https://orcid.org/0009-0000-1826-8505
Elena V. Timokhina, Dr. Med. Sci., Associate Professor, Professor at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russian Federation,
119991, Russia, Moscow, Trubetskaya str., 8-2, timokhina_e_v@staff.sechenov.ru, https://orcid.org/0000-0001-6628-0023
Dzhamilya Kh. Sarakhova, PhD, Deputy Chief Physician in Obstetrics and Gynecology, S.S. Yudin City Clinical Hospital, 115446, Russia, Moscow, Kolomensky Proezd, 4, SarakhovaDK@zdrav.mos.ru, https://orcid.org/0009-0008-0531-0899
Nina A. Mishina, nephrologist, S.S. Yudin City Clinical Hospital, 115446, Russia, Moscow, Kolomensky Proezd, 4, nina.sidoruk@inbox.ru,
https://orcid.org/0009-0005-5887-3546
Yulia A. Samoylova, PhD, Teaching Assistant at the Department of Obstetrics, Gynecology and Perinatology of the N.V. Sklifosovsky Institute of Clinical Medicine,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2,
Samoylova2005@yandex.ru, https://orcid.org/0000-0001-7448-515X
Ksenia I. Seurko, PhD student of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, kseurko@yandex.ru, https://orcid.org/0009-0001-3287-9254
Artem R. Lazarev, student of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
(Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, lazarev_a_r@student.sechenov.ru, https://orcid.org/0009-0005-8029-3441
Lyudmila I. Marchukova, student of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, marchukova_l_i@student.sechenov.ru, https://orcid.org/0009-0001-4073-2818
Alina B. Samara, Resident of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
(Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, linaasamaraa@gmail.com, https://orcid.org/0000-0001-8266-6524
Corresponding author: Aida E. Akhmedova, aida.akhmedova1@gmail.com
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