Assessing Disease Activity During, After Pregnancy in Psoriatic Arthritis

pregnant lady
pregnant lady
Disease activity was altogether low and stable from preconception to 1 year postpartum among pregnant women with psoriatic arthritis.

Peripheral psoriatic arthritis (PsA) disease activity diminished during pregnancy and escalated 6 months after childbirth, according to a study recently published in Arthritis Care & Research. By 1 year postpartum, disease activity tended to stabilize to baseline levels.

This study included a total of 108 pregnancies among 103 women with peripheral PsA, with a mean age of 31 years and a median disease duration of 8 years. Disease activity scores were measured using the 28-joint Disease Activity Score using C-reactive protein (DAS28-CRP-3) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). 

Low mean disease activity scores were observed across the cohort at baseline, though this varied significantly over time (P =.018). Though disease activity decreased before conception and during pregnancy, it increased and peaked 6 months after childbirth. The 6-month disease activity was greater than it had been at 6 weeks (mean DAS28 score, 2.71 vs 2.45; P =.016), and BASDAI showed similar trends. Full data were available for 53 women, 21% of whom had a postpartum DAS28 increase of at least 1.2, 2% of whom experienced a decrease of 1.2, and the rest of whom had a smaller increase. The use of tumor necrosis factor inhibitors (TNFi) was significantly associated with lower disease activity, with a DAS28 score of 2.22 for users and 2.72 for nonusers at 6 months (P =.043).

A linear mixed model was used to examine DAS28-CRP-3 and BASDAI scores at multiple time points throughout the study period. The Psoriasis Area and Severity Index was used to measure psoriatic activity. Self-reporting using the RAND 36-Item Health Survey and the Modified Stanford Health Assessment Questionnaire was used to gather information on bodily pain, mental health, and physical functioning.

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The study researchers concluded that “the majority of women experienced stable, low disease activity. However, disease activity tended to decrease in pregnancy, increased significantly by [6] months postpartum, before returning to baseline by [1] year postpartum. Women using TNFi in pregnancy had significantly lower disease activity throughout the study period.”

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Ursin K, Lydersen S, Skomsvoll JF, Wallenius M. Disease activity of psoriatic arthritis during and after pregnancy: a prospective multicenter study [published online September 7, 2018]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23747