Patient-Reported Disease Activity Correlates With Adverse Pregnancy Outcomes in RA

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Patient-reported measures of systemic lupus erythematosus disease activity are not sufficiently adequate for identifying pregnancies at high risk for complications.
Patient-reported measures of systemic lupus erythematosus disease activity are not sufficiently adequate for identifying pregnancies at high risk for complications.

A clear difference exists in the use of patient-reported measures of disease activity in women with systemic lupus erythematosus (SLE) and those with rheumatoid arthritis (RA), with patient-reported disease activity correlating with adverse pregnancy outcomes in women with RA, but not those with SLE, according to an analysis published in Arthritis Care & Research.

Researchers evaluated the relationship between patient- and physician-reported measures of disease activity and adverse pregnancy outcomes among a total of 225 patients with SLE or RA enrolled in a prospective registry at a single academic center between 2008 and 2016. Among women with RA, patient-reported assessment of disease activity, using the Health Assessment Questionnaire (HAQ), was significantly associated with preterm birth (odds ratio [OR], 5.9; 95% CI, 1.5-23.9; P =.01) and gestational age in weeks (β, −1.5 weeks; 95% CI, −2.6 to −0.4 weeks; P <.01).

The physician-reported assessment of disease activity, using the Physician's Global Assessment, among participants with RA was significantly predictive of preterm birth (OR, 2.1; 95% CI, 1.2-3.5; P <.01), small for gestational age births (OR, 1.8; 95% CI, 1.03-3.1; P =.04), and gestational age in weeks (β, −0.6 weeks; 95% CI, −0.9 to −0.2 weeks; P <.01).

In contrast, patient-reported disease activity measures in women with SLE, including the HAQ, pain, and global health measures, were not significantly associated with adverse pregnancy outcomes. Physicians' measures of disease activity among women with SLE, however, were associated with preterm birth (OR, 2.9; 95% CI, 1.3-6.3; P =.01), cesarean delivery (OR, 2.3; 95% CI, 1.0-5.3; P =.046), and preeclampsia (OR, 2.8; 95% CI, 1.3-6.3; P =.01).

The investigators concluded that among women with SLE, patient-reported measures of physical functioning, pain, and global health are not associated with adverse pregnancy outcomes, but physicians' assessment of SLE activity does offer a useful tool for predicting preterm birth, preeclampsia, and cesarean delivery among these women. These findings imply that patient-reported measures of disease activity are not sufficiently adequate for identifying pregnancies at high risk for complications in SLE. Among women with RA, in contrast, both patient-reported and physician-reported measures of disease activity are useful for predicting adverse pregnancy outcomes.

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Reference

Harris N, Eudy A, Clowse M. Patient-reported disease activity and adverse pregnancy outcomes in systemic lupus erythematosus and rheumatoid arthritis [published online June 15, 2018]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23621

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