Background Pregnancy is the only physiological condition in which Rheumatoid Arthritis (RA) remits spontaneously in approximately 50% of the pregnancies . Although various factors, like hormones and immunoglobulins have been investigated, there is no clear explanation for the gestational improvement . Understanding the influence of pregnancy and especially the impact of subsequent pregnancies, may provide more insight into the pathophysiological mechanisms underlying RA. To our knowledge there has not been any prospective study on this subject until now.
Objectives To determine if changes in disease activity in women with Rheumatoid Arthritis (RA) in one pregnancy are predictive for a subsequent pregnancy.
Methods This study is embedded in the Pregnancy induced Amelioration of Rheumatoid Arthritis (PARA)-study, a nationwide prospective cohort study . There is data available on 27 women who participated during two pregnancies from first trimester unto delivery resulting in a life birth. RA disease courses are categorized as improvement, deterioration, both improvement and deterioration and no change. Improvement and deterioration is determined by calculating changes in DAS28 .
Results In the first pregnancy in total 10 women (37,0%) improved, 6 (22,2%) deteriorated, 6 women (22,2%) both improved and deteriorated, and 5 (18,5%) had no change. In their second pregnancy 10 women (37,0%) improved, 5 (18,5%) deteriorated, 4 women (14,8%) both improved and deteriorated, and 7 (25,9%) had no change at all. Only 4 women (14,8%) had a comparable disease activity course during their first and second pregnancy, whereas treatment remained mostly similar (see figure 1).
Conclusions This prospective study demonstrates that the course of RA-disease activity in subsequent pregnancies is different. This means that we cannot predict the course of the disease activity in following pregnancies based upon an earlier pregnancy.
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Disclosure of Interest H. Ince-Askan Grant/research support from: This study is funded by the Dutch Arthritis Association (Reumafonds). J. Hazes Grant/research support from: This study is funded by the Dutch Arthritis Association (Reumafonds). R. Dolhain Grant/research support from: This study is funded by the Dutch Arthritis Association (Reumafonds).