Assessing Rheumatoid Arthritis Disease Activity During Pregnancy

Around 60% of women with rheumatoid arthritis (RA) experience improvements in disease activity during pregnancy, with 46.7% experiencing disease flares postpartum, according to a study published in The Journal of Rheumatology.  

Researchers performed a systematic review and meta-analysis of prospective studies found through the Cochrane, EMBASE/Medline, LactMed, and PubMed databases to assess the severity of RA during and after pregnancy. Included studies had to have more than 5 participants and RA data obtained through a health professional or clinician using an objective scoring system.

The 10 eligible studies included for analysis yielded a total of 237 patients. Prepartum disease activity data were available for 204 of these, and postpartum disease activity data were available for 135. Disease activity improved in 123 of the 204 pregnancies with prepartum data (60.3%), but this percentage varied from 40.4% to 90% between the individual studies.

Among the 135 pregnancies with postpartum data available, an increase in RA disease activity was observed for 63 (46.7%). All the studies measured postpartum disease activity at 6 weeks, and some measured disease activity at 12, 24, or 26 weeks postpartum. Only 3 of the studies reported pregnancy outcomes, and although these showed no increase in adverse events, 17 of the 135 pregnancies (23%) resulted in premature births and 16 (22%) births were considered small for the newborn’s gestational age.

Study investigators conclude that “60% of patients with RA improve during pregnancy and 47% relapse postpartum. This information is important when counseling patients with RA prepartum.”

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Reference

Jethwa H, Lam S, Smith C, Giles I. Does rheumatoid arthritis really improve during pregnancy? a systematic review and metaanalysis. [published online November 1, 2018]. J Rheumatol. doi:10.3899/jrheum.180226