Does rheumatoid arthritis remit during pregnancy and relapse postpartum?: Results from a nationwide study in the United Kingdom performed prospectively from late pregnancy

Abstract

Objective. To ascertain the influence of pregnancy on disease activity in women with rheumatoid arthritis (RA) during pregnancy and postpartum.Methods. One hundred forty pregnant women were recruited from a nationwide campaign and were followed prospectively in the last trimester and at 1 and 6 months postpartum. Standardized assessment of joint symptoms, examination of inflamed joints, and the Health Assessment Questionnaire (HAQ) were the main measures of disease activity.Results. There was only a modest fall in HAQ scores during pregnancy, with >25% of women having substantial levels of disability. Other parameters of disease activity showed a greater trend toward improvement, although only 23 (16%) were in complete remission (no joints with active disease and no therapy). Similarly, there was relatively little change in the distribution of HAQ scores from pregnancy to postpartum. There was, however, a statistically significant increase in the mean number of inflamed joints compared with the findings during pregnancy. Analysis of the possible influence of treatment suggested that therapy was associated with more severe disease and was not related to reduction in disease activity.Conclusion. This, the largest prospective study of the influence of pregnancy on RA activity, has demonstrated widespread variability in disease response.

Measuring disease activity and functionality during pregnancy in patients with rheumatoid arthritis

“…The median HAQ score of our pregnant patients with RA was 1.0 at the third trimester, and is comparable with the median HAQ score of 0.9 calculated at the third trimester of 140 pregnant patients with inflammatory arthritis prospectively studied by Barrett et al from late pregnancy to postpartum (5). At the third trimester, the patients in the study by Barrett et al completed 2 HAQs, one pertaining to recalled disability before pregnancy and one to current disability.…”

“…The retrospective design of their study may have introduced recall bias. Postpartum, however, the median HAQ scores were again comparable: our patients had a median score of 0.75 and their patients a median score of 0.60 (5).…”

Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis

“…The influence of hormonal changes during pregnancy (estrogen and prolactin) on the immune system is complex and is still not completely understood (20). There is a trend toward clinical improvement in RA patients during pregnancy, but usually there is a worsening of the disease after delivery (21). Glycosylation of IgG, a posttranslational modification, decreases during pregnancy and increases postpartum, both in normal pregnancies and in pregnancies in women with RA (22).…”

The treatment of rheumatoid arthritis during pregnancy

“…However, a recent prospective study has demonstrated extensive variation in the effect that pregnancy may have on rheumatoid arthritis, with only 16% of study participants experiencing complete remission during pregnancy and >25% suffering considerable disability [2].…”