Extended report
Pregnancy and early onset pauciarticular juvenile chronic
arthritis
Elzbieta Musiej-Nowakowskaa, Rafal Ploskib
a Paediatric Clinic,
Institute of Rheumatology, ul Sparta
ska 1, 02-637 Warsaw,
Poland, b HLA
Laboratory, Department of Patophysiology and Immunology, Institute of
Rheumatology, Warsaw, Poland
Correspondence to: Dr E Musiej-Nowakowska.
Accepted for publication 30 March 1999
OBJECTIVES
To
study interaction of early onset pauciarticular juvenile chronic
arthritis (EOP-JCA) and pregnancy in the Polish population, in
particular to confirm the ameliorating effect of pregnancy on disease
activity reported by others and to analyse the factors that govern the
occurrence of postpartum flare, with emphasis on the potential role of
breast feeding.
METHODSThe
reproductive outcome and disease status in 39 adult women with history
of EOP- JCA was examined by means of a questionnaire and an interview.
In all patients the disease onset occurred before the 6th birthday, 19 had persistent pauciarticular JCA (PeEOP-JCA) and 20 had extended
pauciarticular JCA (ExEOP-JCA).
RESULTS23 women had
at least one successful pregnancy, seven had unsuccessful pregnancies
but all of them had also one or more successful pregnancies. Among
those who have never been pregnant (n=16) there was a higher frequency
of eye disease and ExEOP-JCA compared with the rest of the group. In
almost all cases pregnancy was associated with remission of disease
activity, however a postpartum flare appeared after 22 pregnancies
(52%). The flares were more frequent in women who had an active
disease before pregnancy, had a flare after a previous pregnancy and/or
were breast feeding.
CONCLUSIONSIn EOP-JCA
patients pregnancy generally has a good outcome and induces
amelioration of disease activity. After delivery, however, a flare of
disease often appears, especially in women who were breast feeding, had
a postparum flare previously or had an active disease before pregnancy.
The pattern of interaction between disease and pregnancy found in
EOP-JCA makes EOP-JCA similar in this respect to RA, but different from
systemic lupus erythematosus and ankylosing spondylitis.
© 1999 by Annals of the Rheumatic Diseases
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