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Women with rheumatoid arthritis negative for anti-CCP and rheumatoid factor are more likely to improve during pregnancy, whereas in autoantibody positive women autoantibody levels are not influenced by pregnancy.
  1. Yaël A de Man (y.a.deman{at}erasmusmc.nl)
  1. Erasmus MC, University Medical Center Rotterdam, Dept of Rheumatology, Netherlands
    1. Liesbeth E Bakker-Jonges
    1. Erasmus MC, University Medical Center Rotterdam, Dept of Immunology, Netherlands
      1. Diana B C M Dufour-van den Goorbergh
      1. Erasmus MC, University Medical Center Rotterdam, Dept of Immunology, Netherlands
        1. Sonja PR Tillemans
        1. Erasmus MC, University Medical Center Rotterdam, Dept of Rheumatology, Netherlands
          1. Herbert Hooijkaas
          1. Erasmus MC, University Medical Center Rotterdam, Dept of Immunology, Netherlands
            1. Johanna M W Hazes
            1. Erasmus MC, University Medical Center Rotterdam, Dept of Rheumatology, Netherlands
              1. Radboud JEM Dolhain
              1. Erasmus MC, University Medical Center Rotterdam, Dept of Rheumatology, Netherlands

                Abstract

                Objectives: To determine whether changes in levels of anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) are associated with the spontaneous improvement of rheumatoid arthritis (RA) during pregnancy and with the subsequent flare postpartum.

                Methods: Disease activity scores from the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA)-study of 118 patients were available for analysis. Before conception (if applicable), at each trimester and at 6, 12 and 26 weeks postpartum levels of the autoantibodies anti-CCP, IgM-RF, IgG-RF and IgA-RF were determined. Responses in disease activity were classified according EULAR response criteria during pregnancy and postpartum, and associated with the presence or absence of autoantibodies.

                Results: The median levels of anti-CCP and all subclasses of RF during pregnancy were stable, whereas postpartum the levels of anti-CCP, IgM-RF and IgA-RF declined. A significantly higher percentage of women without autoantibodies (both anti-CCP and RF negative) improved compared with women positive for either or both autoantibodies (75% vs 39%, p=0.01). The occurrence of a flare postpartum was comparable between these groups.

                Conclusions: Improvement of disease activity of RA during pregnancy was not associated with changes in levels of autoantibodies during pregnancy, however, improvement may occur more frequently in the absence of anti-CCP and RF.

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