October 10, 2018
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PsA Disease Activity in Women Highest at 6 Months Postpartum

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Among women with peripheral psoriatic arthritis during and after pregnancy, disease activity was highest at 6 months following delivery, but in general was low and stable from pre-pregnancy to 1 year postpartum, according to data published in Arthritis Care & Research.

“While a study from 2008 confirmed that women with rheumatoid arthritis achieve remission in pregnancy, though less frequently than previously described, little is known about PsA and pregnancy,” Kristin Ursin, MD, of Trondheim University Hospital in Norway, and colleagues wrote. “The only prospective study on the subject demonstrated improvement in pregnancy and deterioration postpartum. This study is from 1992, before the widespread use of biological disease-modifying antirheumatic drugs. Two small retrospective studies have later shown diverging results concerning disease activity during pregnancy in PsA.”

To analyze disease activity among women with peripheral PsA during and after pregnancy, Ursin and colleagues studied data in the RevNatus nationwide Norwegian observational register. According to the researchers, the database follows women with inflammatory rheumatic diseases from prior to conception to 1 year after delivery. Between January 2006 and October 2017, the researchers identified 108 pregnancies, in 103 women with PsA, that resulted in a live birth.

 
Among women with peripheral PsA during and after pregnancy, disease activity was highest at 6 months following delivery, but in general was low and stable from pre-pregnancy to 1 year postpartum, according to data.
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Each patient’s disease activity was assessed prospectively seven times before, during and after pregnancy, using the DAS28CRP3 and BASDAI measures. The researchers used a linear mixed model to assess disease activity scores at each assessment and conducted additional analyses with “tumor necrosis factor inhibitor in pregnancy” as a covariate.

According to Ursin and colleagues, approximately 75% of patients included in the analysis were in remission or had low disease activity — according to DAS28 — during and after pregnancy.

However, the researchers also noted that disease activity decreased during pregnancy and then increased within 6 months following birth. Disease activity at 6 months postpartum was significantly higher, with a mean DAS28 of 2.71, than at 6 weeks after delivery, which had a mean DAS28 of 2.45 (P = .016). In addition, patients using TNF inhibitors during pregnancy had significantly lower disease activity than those who did not (P = .043). Using the BASDAI measure, disease activity scores were also low and stable, yet significantly higher at 6 months postpartum compared to 6 weeks postpartum (P = .013).

“In this large prospective study on disease activity of PsA in pregnancy, we found that the majority of women experienced stable, low disease activity,” Ursin and colleagues wrote. “However, disease activity tended to decrease in pregnancy, increased significantly by 6 months postpartum, before returning to baseline by one year postpartum. Women using TNF [inhibitor] in pregnancy had significantly lower disease activity throughout the study period.” – by Jason Laday

Disclosure: Ursin reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.