Background Very little has been published about psoriatic arthritis (PsA) in pregnancy, and it remains unknown whether pregnancy outcomes are impacted by this disease or whether disease activity is changed by pregnancy or delivery.
Objectives To discover the rate of pregnancy complications for women with psoriatic arthritis, and to determine whether psoriasis and the associated arthritis change during and following pregnancy.
Methods A retrospective survey was completed by 40 women aged 20–50 years with psoriatic arthritis managed at a university center. Each survey collected information about infertility, pregnancy outcomes and complications, as well as patient-reported assessments of changes in both skin and joint disease activity at the onset of pregnancy, over the course of the pregnancy, and in the months following pregnancy. Simple statistics were used to compare outcomes before and after the diagnosis of PsA.
Results The survey was completed by 40 women with PsA. The majority (93%) were white, non-Hispanic with a high level of education (40% completed college and another 30% either started or finished a graduate degree); 62.5% were married. The average age at the time of the study was 37.4 (SD 7.9) years and age at PsA diagnosis was 30.9 (8.4) years.
Twenty-five women reported they had ever tried to become pregnant, and of those, 9 had been unable to become pregnant after 12 months of trying or had been diagnosed with infertility by a physician (36%). The reasons for infertility or inability to become pregnant included polycystic ovarian syndrome (44%), problem with ovulation (11%), problem with uterus (11%), elevated prolactin (11%), infection in pelvic area (11%), and/or cervical problems (30%). Infertility was unexplained in 33%.
There were 70 pregnancies to 26 patients, with 37 pregnancies occurring after the diagnosis of PsA (see table). Pregnancy outcomes following PsA diagnosis were worse than those prior to PsA diagnosis, particularly the rate of pregnancy loss (32% compared to 12%; p=0.05) and preterm birth (48% compared to 21%; p=0.02). Only 24% of patients took psoriasis or arthritis medications during pregnancy. The most commonly used medications during pregnancy were TNF inhibitors (16%), corticosteroids (8%), and DMARDs (5%).
The large majority of patients had minimal arthritis and psoriasis during pregnancy. Only 12% had moderate and 6% had severe arthritis. Similarly, only 10% had moderate and 7% had severe psoriasis. During and following pregnancy, about half of all patients reported no change in either joint or skin activity during and follow pregnancy, with fairly equal numbers reporting improved and worsened arthritis. On the other hand, 42% had improved psoriasis during pregnancy compared to 6% with worsened. There did not appear to be a significant postpartum flare.
Conclusions Our analysis found that among women with PsA who have tried to become pregnant, 36% experienced infertility, primarily due to PCOS. Compared to pregnancies occurring before the diagnosis of PsA, pregnancies after PsA diagnosis had a lower frequency of live births and a higher frequency of preterm births. Overall, in this cohort of women with mostly mild disease during pregnancy, arthritis pain and psoriasis activity did not appear to substantially worsen during pregnancy.
Acknowledgements This study was funded by Janssen.
Disclosure of Interest None declared