Ankylosing spondylitis and pregnancy.

Much has been written on ankylosing spondylitis but nothing regarding its hindrance to pregnancy or its interference with normal labour. Since this disease is one involving pelvic joints, and since, as the disease progresses, ankylosis of the joints occurs, it is possible that ankylosing spondylitis would be a hindrance in pregnancy and in normal labour. Polley and Slocumb's (1947) short but comprehensive study of 1,035 cases of ankylosing spondylitis is the best appearing in the literature. This series included 931 men and 104 women. The authors made no mention of its association with pregnancy. Undoubtedly some of these women enjoyed the pleasures of connubial relationship which in some must have resulted in gestation. Hench and others (1947) recently reviewed the clinical status of this disease but failed to discuss its effect on pregnancy and labour. Freyberg, in an open discussion of this subject at the March 1947 postgraduate course in rheumatic diseases at the Mayo Clinic, said that he had never known a woman with rheumatoid spondylitis to become pregnant. The sacro-iliac joints show evidence of arthritis in approximately 99 per cent. of cases of ankylosing spondylitis. The small apophyseal joints of the vertebrae are usually involved later than the sacroiliac joints. On rare occasions x-ray evidence is lacking in the sacro-iliac joints but is found in the spine (Buckley, 1936).