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Abstract
Background The few previous studies on disease activity of psoriatic arthritis in pregnancy have shown diverging results.1–3 None of the studies used validated disease activity measures and the only prospective study was conducted before the widespread use of biological DMARDs.
Objectives The aim of this project was to prospectively study disease activity in women with psoriatic arthritis before, during and after pregnancy with DAS28-CRP-3 as disease activity measure.
Methods RevNatus is a Norwegian nationwide register designed for the follow-up of pregnant women with rheumatic diseases. Our study comprised 108 pregnancies in 103 women with psoriatic arthritis with mainly peripheral involvement, included in RevNatus between 2006 - 2017. The women had seven visits at a rheumatology unit; before pregnancy, in each trimester, and six weeks, six months and twelve months postpartum. DAS28-CRP-3-scores from each visit were analysed in a linear mixed model. We did additional analyses with “tumour necrosis factor inhibitor (TNFi) in pregnancy (yes/no)” as covariate.
Results Altogether, our study demonstrated stable, low disease activity during and after pregnancy in women with psoriatic arthritis. However, as shown in figure 1, disease activity decreased in pregnancy and increased within six months postpartum, with disease activity six months postpartum significantly higher than six weeks postpartum (estimated mean DAS28 2.71 vs. 2.45, p=0.016). Women using TNFi in pregnancy had significantly lower disease activity than women not using TNFi (estimated mean DAS28 six weeks postpartum 1.97 vs. 2.48, p=0.039).
also shows self-reported pain, physical functioning and mental health throughout the study period.
Conclusions Studying women with psoriatic arthritis, we found that disease activity was highest six months postpartum, but altogether stable in the period from planning pregnancy to one year after delivery. Women using TNFi in pregnancy had significantly lower disease activity.
References [1] Ostensen M. The effect of pregnancy on ankylosing spondylitis, psoriatic arthritis, and juvenile rheumatoid arthritis. Am J Reprod Immunol1992;28(3–4):235–7.
[2] Mouyis MA, Thornton CC, Williams D, Giles IP. Pregnancy Outcomes in Patients with Psoriatic Arthritis. J Rheumatol2017;44(1):128–9.
[3] Polachek A, Li S, Polachek IS, Chandran V, Gladman D. Psoriatic arthritis disease activity during pregnancy and the first-year postpartum. Semin Arthritis Rheum2017.
Disclosure of Interest None declared