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

June 2, 2009

Ann Rheum Dis. 2009 Mar 11.

Women with rheumatoid arthritis negative for anti-CCP and rheumatoid

factor are more likely to improve during pregnancy, whereas in

autoantibody positive women autoantibody levels are not influenced by

pregnancy.

de Man YA, Bakker-Jonges LE, Dufour-van den Goorbergh DB, Tillemans

SP, Hooijkaas H, Hazes JM, Dolhain RJ.

Erasmus MC, University Medical Center Rotterdam, Dept of Rheumatology,

Netherlands.

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 postpartum.

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 postpartum levels of the

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

Responses in disease activity were classified according EULAR response

criteria during pregnancy and postpartum, 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 postpartum the levels of anti-CCP,

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

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

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

39%, p=0.01). The occurrence of a flare postpartum 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.

PMID: 19282308

Not an MD

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