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