Disease activity of rheumatoid arthritis during pregnancy: Results from a nationwide prospective study

Abstract

Objective. According to common knowledge and retrospective studies, approximately 75-90% of patients with rheumatoid arthritis (RA) will improve during pregnancy. Prospective data on disease activity during pregnancy are limited. Therefore, this study aimed to prospectively determine the disease activity during pregnancy in RA patients treated in an era of new treatment options. Methods. For 84 RA patients (American College of Rheumatology criteria), a Disease Activity Score in 28 joints (DAS28) and medication use were obtained, before conception if possible, at each trimester of pregnancy and at 6, 12, and 26 weeks postpartum. Improvement and deterioration were determined by assessing changes in DAS28 and by applying the DAS28-derived European League Against Rheumatism (EULAR) response criteria. Results. Disease activity decreased with statistical significance (P ‫؍‬ 0.035) during pregnancy and increased postpartum. In patients with at least moderate disease activity in the first trimester (n ‫؍‬ 52), at least 48% had a moderate response during pregnancy according to EULAR-defined response criteria. In patients with low disease activity in the first trimester (n ‫؍‬ 32), disease activity was stable during pregnancy. Thirty-nine percent of patients had at least a moderate flare postpartum according to reversed EULAR response criteria. Less medication was used during pregnancy compared with before conception and compared with postpartum. Conclusion. This study demonstrates that patients achieve remission during pregnancy and deteriorate postpartum, although less frequently than previously described.

Pregnancy Outcomes After Exposure to Certolizumab Pegol

“…Up to half of pregnant patients with rheumatic diseases and the majority of those with inflammatory bowel disease (IBD) experience active disease and need treatment 3, 4. High disease activity is associated with an increased risk of pregnancy complications and adverse outcomes, including preeclampsia, preterm delivery, low birth weight, small for gestational age, and fetal loss 5, 6, 7, 8, 9, 10, 11, 12, 13. Adequate disease control during pregnancy is therefore paramount for fetal and maternal health, as acknowledged by recent publications 6, 14, 15, 16, and the risks of untreated disease during pregnancy should be evaluated against the risks related to drug exposure of mother and fetus.…”

Rheumatoid Arthritis During Pregnancy and Postnatal Catch‐Up Growth in the Offspring

“…More than one-half of the mothers in this study were taking a medication for RA during pregnancy, but only one-fifth used a combination of medication. In addition, studies have demonstrated that low disease activity during conception is relevant to the maintenance of stable, low disease activity during pregnancy (8,17). Others have shown that pregnant women with RA who discontinued their medications during pregnancy had worse outcomes, in terms of preterm delivery, than did women who continued their medications (18).…”

“…The study cohort consisted of 255 healthy children of mothers who participated in the Pregnancyinduced Amelioration of Rheumatoid Arthritis (PARA) study, a prospective, nationwide cohort study on pregnancy and RA in The Netherlands that started in 2002 and ended in 2010 (8). Women were recruited by their rheumatologist when they met the American College of Rheumatology 1987 revised criteria for RA (10) and were eligible for inclusion if they were planning to conceive or were already pregnant.…”

“…However, with such a decision, there is a lack of awareness of the negative effects of elevated disease activity in the mother, which is a potential risk when medication use is minimized. Some physicians and patients may assume that disease remission will occur during the pregnancy, which is true for only one-quarter of patients (8). The presence of RF and ACPAs is indicative of a more severe type of RA, characterized by higher disease activity, more extensive joint destruction, and extraarticular manifestations (9).…”

Rheumatoid Arthritis: Prospects for Stopping the Runaway Train by Reintroduction of Tolerance

“…It has long been recognized that pregnant patients with rheumatoid arthritis can often undergo significant clinical improvement, followed by worsening disease after delivery [66][67][68][69]. This observation, in fact, helped lead Hench to the discovery of corticosteroids as the first treatment for RA [70].…”