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FRI0081 Prospective Study of Pregnant Women with Rheumatoid Arthritis: Can we Apply DAS28 to this Population?
  1. J. Madruga Dias1,
  2. M.M. Costa2,
  3. L. Pinto3,
  4. L. Graça3,
  5. J.A. Pereira da Silva2
  1. 1Rheumatology, Centro Hospitalar Médio Tejo, EPE, Torres Novas
  2. 2Rheumatology
  3. 3Obstetrics, Centro Hospitalar Lisboa Norte, EPE, Lisbon, Portugal

Abstract

Background Pregnancy has a positive imunomodulador effect in Rheumatoid Arthritis (RA) patients [1,2,3]. In postpartum, disease relapse is reported to occur in as much as 92% of cases [2]. The methods of measuring disease activity in RA are not yet validated for pregnancy and their applicability in this context is questionable. C-Reactive protein (CRP) and especially erythrocyte sedimentation rate (ESR) are increased during normal pregnancy [4,5] and this might affect disease activity scores and their interpretation. Disease Activity Score (DAS)28 is not yet proven to correlate with disease activity in pregnant RA patients.

Objectives To study and characterize a population of women with rheumatoid arthritis before, during pregnancy and post-delivery and to evaluate disease activity indexes in this population.

Methods We prospectively evaluated 25 women with rheumatoid arthritis, with a mean age of 32.3±4.3 years and mean disease duration of 6.3±4.4 years.

We considered RA patients with >1 swollen or tender joint (68 joints) and a visual analogue scale (VAS) of pain or disease ≥10 as active. DAS28(4v)-CRP and DAS28(4v)-ESR were calculated.

Statistical treatment was performed using SPSS-20.

Results Before pregnancy, patients had a mean DAS28(4v)-ESR of 2,42 (remission), yet during the first, second and third trimesters, mean DAS28(4v)-ESR was above 2,6 and below 3,2 suggesting low disease activity. Post partum, DAS28(4v)-ESR returned to remission values (2,29). The swollen and tender 68 joint count, pain VAS and disease VAS were low during the whole pregnancy for most patients and low in the overall patient mean.

During pregnancy, using our considerations for disease activity, there was a reduction in RA activity from the first evaluation until the 3rd trimester (p=0,014). No women stopped working due to active RA.

DAS28(4v)-ESR/CRP were not correlated with disease activity.

Conclusions Disease activity during pregnancy is decreased in RA. DAS28(4v)-CRP seemed better than DAS28(4v)-ESR in measuring disease activity, but neither correlated with our clinical evaluation. DAS28 values were probably elevated due to the increased levels of both CRP and ESR during pregnancy.

References

  1. Østensen M, Villiger PM, Förger F. Interaction of pregnancy and autoimmune rheumatic disease. Autoimmun Rev. 2012 May;11(6-7):A437-46.

  2. Zrour SH, Boumiza R, Sakly N, Mannai R, Korbaa W, Younes M, Bejia I, Touzi M, Bergaoui N. The impact of pregnancy on rheumatoid arthritis outcome: the role of maternofetal HLA class II disparity. Joint Bone Spine. 2010 Jan;77(1):36-40.

  3. Nelson JL, Hughes KA, Smith AG, Nisperos BB, Branchaud AM, Hansen JA. Remission of rheumatoid arthritis during pregnancy and maternal-fetal class II alloantigen disparity. Am J Reprod Immunol. 1992 Oct-Dec;28(3-4):226-7.

  4. van den Broe NR, Letsky EA. Pregnancy and the erythrocyte sedimentation rate. BJOG. 2001 Nov;108(11):1164-7

  5. Salawu L, Durosinmi MA. Erythrocyte rate and plasma viscosity in health and disease. Niger J Med. 2001 Jan-Mar;10(1):11-3.

Disclosure of Interest None declared

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