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SAT0137 Effect of Rheumatoid Arthritis Activity in First Trimester of Pregnancy on the Disease during Gestation and Postpartum
  1. E. Matianova,
  2. N. Kosheleva,
  3. A. Zemfira,
  4. N. Evgeniy
  1. Nasonova Research Institute of Rheumatology, Moscow, Russia, Moscow, Russian Federation

Abstract

Background Known that pregnancy in 66-91% of patients (pts) with rheumatoid arthritis (RA) contributes to improve health and reduce disease activity during gestation. The remaining 9-34% activity dynamics not observed or RA escalates. They require special attention rheumatologist and an obstetrician-gynecologist.

Objectives To clarify the influence of RA activity in the I-st trimester on the disease during pregnancy and postpartum.

Methods 37 pregnancies in 34 pts with RA (ACR, 1987) (median age – 29[26;31] y.o., disease duration 8[4;16] years) prospectively examined at 10, 22 and 32 (±2) weeks of pregnancy and at 3 months postpartum. Anti-CCP positive (58.8%) and RF positive (64.7%) RA prevailed. 25 (67.6%) pts took 5-10 mg per day gluco-corticosteroids (GC) per os; observations made during correction therapy. Assessment of RA activity was carried out by DAS28CRP.

Results Pts have been divided into 3 groups according to disease activity in the I-st trimester. The Group matched by age, duration and stage of RA.

- Group “A” (n=7) – high disease activity (DAS28CRP>4,1)

- Group “B” (n=14) – low and moderate disease activity (DAS28CRP=2,3-4,1)

- Group “C” (n=16) – RA in remission (DAS28CRP<2.3)

In ”A” progressively decreased disease activity on a background of pregnancy (p(I-III)=0.003). In the III-th trimester remission was observed in 2 (27.6%) pts, in 1 (14.3%) RA activity decreased to moderate, in 4 (57.1%) remained in the range high. The initial dose of GC was higher than in the other groups, at III-th trimester GC obtained 100% of pts. In “B” RA activity dynamic during pregnancy was minimal with the tendency to decrease. In III-rd trimester remission was observed in 3 (21.4%) pts, and a high activity in 2 (14.3%). In “C” RA activity increased progressively, reaching low (n=2, 12.5%), moderate (n=3, 18.8%) and even higher (n=1, 6.3%) activity level to the III-th trimester. In 10 (62.5%) pts remained in remission. While 6 (37.5%) pts in the group did not receive anti-inflammatory therapy during pregnancy. Postpartum RA exacerbation was observed in all groups. In group “A” active RA therapy started earlier. After 3 months after birth DAS28CRP in group “A” was reduced to moderate values and was lower than the I-st trimester. In group “B” RA activity was increased in 9 (64.3%) cases (p=0.04) and was slightly higher than the I-st trimester. In the “C” was aggravation in 10 (62.5%) pts (p=0.03) and DAS28CRP was significantly higher than in I-st trimester (p=0.002).

Conclusions Exacerbation of RA or no improvement during pregnancy was observed in 43.2%, improvement in 29.8%, maintaining remission in 27%; exacerbation or high RA activity after childbirth - in 59.5%. Pts with high RA activity in I-st trimester was observed its reduction during pregnancy and after birth (p<0.05). In patients with RA remission in I-st trimester recorded increased activity during pregnancy and after childbirth. This trend determined by ongoing therapy that corrected depending on disease activity.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.5637

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