Background Pregnancy is the only natural condition in which Rheumatoid Arthritis (RA) remits spontaneously in approximately half of the pregnancies . Many physicians try to taper or stop medication when a women conceives in order to prevent drug related side effects for mother and child. However, 50% of the patients still has active disease in the third trimester of pregnancy1. Factors that can identify patients in whom medication can be safely tapered during pregnancy are therefore needed.
Objectives To determine clinical factors associated with lower disease activity in the third trimester during pregnancy in women with Rheumatoid Arthritis (RA) and thereby to identify patients in whom medication can be safely tapered during pregnancy.
Methods This study is embedded in the Pregnancy induced Amelioration of Rheumatoid Arthritis (PARA)-study, a nationwide prospective cohort study. There was data available on 190 pregnancies from first trimester unto delivery. Disease activity was measured using the Disease Activity Score in 28 joints (DAS28). A multivariate linear regression analysis was performed on the DAS28 in the third trimester. Independent covariates in these models: the DAS28 in the first trimester, prednisone and sulfasalazine use in the first trimester, parity, methotrexate use in past, autoantibody status (either rheumatoid factor or ACPA positive), presence of erosions and duration of RA.
Results In the multivariate linear regression model, see table 1., a higher DAS28 in the first trimester, the use of prednisone and the presence of autoantibodies were statistically significantly associated with a higher DAS28 in the third trimester (p-values <0.001, 0.032 and 0.014 respectively).
Conclusions The DAS28 in the first trimester, the autoantibody status and the use of prednisone were associated with RA disease activity in the third trimester. Female RA patients who have a lower DAS28 in the first trimester are likely to have lower disease activity in the third trimester, especially if they are autoantibody negative and if they do not use prednisone. In these patients, it may be considered to safely taper their medication.
de Man YA, Dolhain RJ, van de Geijn FE, Willemsen SP, Hazes JM. Disease activity of rheumatoid arthritis during pregnancy: results from a nationwide prospective study. Arthritis Rheum 2008;59:1241–8.
Funding Dr. R.J.E.M. Dolhain received unrestricted research grants from the Dutch Arthritis Association (Reumafonds), a non-commercial fund raising organization, and from UCB Pharma BV.
Conflicts of interest None.
Disclosure of Interest None declared