Psoriatic Arthritis Disease Activity Frequently Improves During Pregnancy, Flares Postpartum

Pregnant women with psoriatic arthritis (PsA) generally experienced a reduction in disease activity during their pregnancy and then flared postpartum, according to a report published in the Annals of the Rheumatic Diseases.

The usual disease course during and after pregnancy is well established for autoimmune conditions such as rheumatoid arthritis, but many studies that have examined the PsA disease course during pregnancy were conducted before the widespread use of biologic disease-modifying antirheumatic drugs (bDMARDs), and have produced unclear and conflicting results. Therefore, investigators sought to describe pregnancy outcomes in the PsA population, based on patients visiting a rheumatological reproductive specialty service.

Consecutive outpatients with PsA who were already pregnant or planning to become pregnant were recruited for an observational clinical study and prospectively followed during and after pregnancy. Researchers measured disease activity and any associated maternal or fetal consequences. As there are currently no accepted valid criteria for assessing disease activity in pregnant patients with PsA, researchers chose the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP-3) as their standardized metric.

Of 14 patients who were reviewed (mean age, 34 years), 12 became pregnant (20 pregnancies in total). Medications prescribed during pregnancy included conventional DMARDs, bDMARDs, oral prednisolone, sulfasalazine, hydroxychloroquine, aspirin, and nonsteroidal anti-inflammatory drugs. Of 9 pregnancies, bDMARD therapy was discontinued during the first trimester in 5 cases and during the second trimester in 1 case. Prednisolone was initiated before and during pregnancy in 3 and 2 cases, respectively. Both sulfasalazine and hydroxychloroquine were taken throughout the gestational period and continued postpartum.

Overall disease activity trends demonstrated a decrease in mean DAS28-CRP-3 scores during pregnancy and an increase postpartum, particularly through the first 6 weeks. Using the European League Against Rheumatism response criteria, nearly half the patients experienced symptom reduction while pregnant, and one-third flared after delivery.

Mean gestational age at birth was 39.62 weeks, and mean birth weight was 3.54 kg. Although miscarriages occurred more often in the study sample compared with the general population (32% vs 20%), birth weights (3.54 kg vs 3.49 kg) and rates of breastfeeding at 6 months (62% vs 55%) were comparable.

“In conclusion, we observed that PsA disease control generally improved during pregnancy and flared post partum,” noted the authors, adding, “Awareness of this is important to ensure prompt reintroduction of [DMARD] therapy post partum when appropriate.”

Reference

Murray K, Moore L, Mcauliffe F, Veale DJ. Reproductive health outcomes in women with psoriatic arthritis [published online February 15, 2019]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-214790