RESEARCH - Disease activity of RA during pregnancy: results from a nationwide prospective study

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Arthritis Rheum. 2008 Sep 15;59(9):1241-8.

Disease activity of rheumatoid arthritis during pregnancy: Results

from a nationwide prospective study.

de Man YA, Dolhain RJ, van de Geijn FE, Willemsen SP, Hazes JM.

Erasmus Medical Center, University Medical Center Rotterdam,

Rotterdam, The Netherlands.

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.

PMID: 18759316

http://www.ncbi.nlm.nih.gov/pubmed/18759316

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