Background Several studies have reported an interaction between pregnancy and inflammatory rheumatic disease. Pregnancy may affect the rheumatic disease, and vice versa. Previous studies have shown that about 50 % of women with juvenile idiopathic arthritis (JIA) can expect a flare in disease activity within 3-6 months postpartum.
Objectives To study disease activity from pre-pregnancy to six months postpartum in women with JIA.
Methods A total of 22 women with JIA were included in the study. An inconsistent number of women (N= 6-22), due to missing visits, were assessed prospectively related to pregnancy. To assess disease activity at each visit, the DAS-28-CRP(3) with 28 joint count, c-reactive protein (CRP) was used. In addition medical use was registered by the number of disease modifying anti rheumatic drugs (DMARDs). Registrations were recorded pre-pregnancy, 1st trimester (1-12 weeks), 2nd trimester (13-27 weeks), 3rd trimester (28-40 weeks), six weeks postpartum and six months postpartum. Non-parametric tests using the Wilcoxon test for related samples were performed. DAS-28-CRP(3) scores was tested from pre-pregnancy to each visit, and changes from visit to visit was explored. Minimal clinical important difference (MCID) was set to 0.6 according to EULAR response criteria (1) for moderate change in DAS-28-CRP(3).
Results Mean age was 27.8 years (range 18-36 years), and mean disease duration was 20.5 (range 8-33). Pre-pregnancy the women used a mean of 0.53 DMARDs (range 0-2), six weeks postpartum a mean of 0.39 DMARDs (range 0-1) and six months postpartum a mean of 0.57 DMARDs (range 0-2). There was a wide range in DAS-28-CRP(3) scores but there were no statistical significant changes in DAS-28-CRP(3) from pre-pregnancy to six weeks and six months post partum (see table 1).
Conclusions There were no significant changes in DAS-28-CRP(3) during pregnancy compared with pre-pregnancy scores. The women had temporary better scores in disease activity at 3rd trimester compared to six weeks postpartum. When comparing DAS-28-CRP(3) from pre-pregnancy to six weeks and six months postpartum, there was no change. Overall, the disease activity scores improved though pregnancy, and a clinically significant flare was not observed postpartum.
Franse J, van Riel PLCM. The Disease Activity Score and the EULAR response criteria. Clin Exp Rheumatol 2005; 23(Suppl. 39): S93-S99.
Disclosure of Interest None Declared
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