According to new data, disease activity in patients with rheumatoid arthritis (RA) is significantly reduced during pregnancy.
RA improved significantly from the first trimester to the third trimester of the participants pregnancy and this effect extended into the postpartum stage.
This is the first prospective study to confirm the relationship between RA and pregnancy, tracking 124 female RA patients throughout their pregnancy and at 6, 12 and 26 weeks postpartum. The RA improvement was seen in 40 pct of patients.
Furthermore, 64 pct of patients remained relatively stable or improved postpartum. Only a third of patients (36 pct) experienced flares (periods of worsened symptoms), 5 pct severely.
Whilst previous literature has suggested an improvement of RA in pregnancy, this is the first prospective study to put a figure to this. The percentage of patients experiencing flares was much lower than previous studies, which we attribute to adequately-used DMARDs and biologicals to suppress disease activity postpartum, Dr Yael de Man of Erasmus MC University Medical Center, Rotterdam, The Netherlands, who performed this research, said.
It is also interesting to note the existence of a complex interaction between female hormones during pregnancy and the epidemiology of RA, which may contribute to the development of new prevention and treatment approaches, he added.
In the study, patients were assessed according to medication use, the Disease Activity Score DAS28 and the level of inflammation marker C-reactive protein (CRP). Disease activity was calculated with DAS28-CRP with 3 variables (DAS28-CRP-3).
The change between the DAS28 at first and third trimester was used to categorise patients according to the EULAR response criteria into good, moderate and non-responders. The change between the DAS28 at 6 weeks and 12 or 26 weeks postpartum was used to determine if a severe or
moderate flare was present.
The researchers found that DAS28 decreased significantly over the three terms of the pregnancies.
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