RESEARCH - Women with RA who are negative for anti-CCP and RF are more likely to improve during pregnancy

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Ann Rheum Dis 2010;69:420-423 doi:10.1136/ard.2008.104331

Clinical and epidemiological research

Concise report

Women with rheumatoid arthritis negative for anti-cyclic citrullinated

peptide and rheumatoid factor are more likely to improve during

pregnancy, whereas in autoantibody-positive women autoantibody levels

are not influenced by pregnancy

Y A de Man1, L E Bakker-Jonges2, C M Dufour-van den Goorbergh2, S P R

Tillemans1, H Hooijkaas2, J M W Hazes1, R J E M Dolhain1

+ Author Affiliations

1Department of Rheumatology, Erasmus MC, University Medical Center

Rotterdam, Rotterdam, The Netherlands

2Department of Immunology, Erasmus MC, University Medical Center

Rotterdam, Rotterdam, The Netherlands

Abstract

Objectives: To determine whether changes in levels of anti-cyclic

citrullinated peptide (anti-CCP) and rheumatoid factor (RF) are

associated with the spontaneous improvement of rheumatoid arthritis

(RA) during pregnancy and with the subsequent flare post partum.

Methods: Disease activity scores from the Pregnancy-induced

Amelioration of Rheumatoid Arthritis (PARA) study of 118 patients were

available for analysis. Before conception (if applicable), at each

trimester and at 6, 12 and 26 weeks post partum, levels of the

autoantibodies anti-CCP, IgM-RF, IgG-RF and IgA-RF were determined.

Responses in disease activity were classified according to European

League Against Rheumatism (EULAR) response criteria during pregnancy

and post partum, and associated with the presence or absence of

autoantibodies.

Results: The median levels of anti-CCP and all subclasses of RF during

pregnancy were stable, whereas post partum the levels of anti-CCP,

IgM-RF and IgA-RF declined. A significantly higher percentage of women

without autoantibodies (negative for anti-CCP and RF) improved

compared with women positive for either or both autoantibodies (75% vs

39%, p = 0.01). The occurrence of a flare post partum was comparable

between these groups.

Conclusions: Improvement of disease activity of RA during pregnancy

was not associated with changes in levels of autoantibodies during

pregnancy, however, improvement may occur more frequently in the

absence of anti-CCP and RF.

http://ard.bmj.com/content/69/2/420.abstract?etoc

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