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Women with rheumatoid arthritis negative for anti-cyclic citrullinated peptide and rheumatoid factor are more likely to improve during pregnancy, whereas in autoantibody-positive women autoantibody levels are not influenced by pregnancy
  1. Y A de Man1,
  2. L E Bakker-Jonges2,
  3. C M Dufour-van den Goorbergh2,
  4. S P R Tillemans1,
  5. H Hooijkaas2,
  6. J M W Hazes1,
  7. R J E M Dolhain1
  1. 1
    Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2
    Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Y A de Man, Erasmus MC, University Medical Center Rotterdam, Department of Rheumatology, Room Ee-965, Miss Yaël A de Man, PO Box 2040, 3000 CA Rotterdam, The Netherlands; y.a.deman{at}


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 post partum.

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 post partum, levels of the autoantibodies anti-CCP, IgM-RF, IgG-RF and IgA-RF were determined. Responses in disease activity were classified according to European League Against Rheumatism (EULAR) response criteria during pregnancy and post partum, 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 post partum the levels of anti-CCP, IgM-RF and IgA-RF declined. A significantly higher percentage of women without autoantibodies (negative for anti-CCP and RF) improved compared with women positive for either or both autoantibodies (75% vs 39%, p = 0.01). The occurrence of a flare post partum 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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  • ▸ Additional data (supplementary files 1–3) are published online only at

  • Funding This study was funded by the Dutch Arthritis Association (“Reumafonds”).

  • Competing interests None.

  • Ethics approval The protocol was approved by the Medical Ethics Committee of the Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. All patients gave written informed consent.

  • Provenance and Peer review Not commissioned; externally peer reviewed.