ObjectiveTo investigate outcome and course of pregnancies in women with axial spondyloarthritis (axSpA) in a pooled data analysis of pregnancy registries in rheumatology.MethodsProspectively followed women with axSpA, fulfilling ASAS classification criteria and for whom a pregnancy outcome was reported, were eligible for the analysis. Anonymised data of four registries was pooled. Rates of adverse pregnancy outcomes were calculated. Systemic inflammation, disease activity and treatment patterns with tumour necrosis factor inhibitor (TNFi) before, during and after pregnancy were analysed.ResultsIn a total of 332 pregnancies from 304 axSpA women, 98.8% of the pregnancies resulted in live birth. Mean maternal age was 31 years and disease duration 5 years. Most of these patients received pre-conception counselling (78.4%). Before pregnancy, 53% received TNFi treatment, 27.5% in first and 21.4% in third trimester. Pregnancy and neonatal outcomes were favourable with rates of 2.2% for pre-eclampsia, 4.9% for preterm birth, 3.1% for low birth weight and 9.5% for small for gestational age. Neonates were delivered by caesarean section in 27.7% of pregnancies, of which 47.4% were emergencies. Pooled mean CRP was 4 mg/L before conception peaking in the second trimester at 9.4 mg/L. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was below 4 at all time-points.ConclusionsPooled rates of most outcomes were better than what had been reported in the literature and within expected rates of those reported for the general population. Pre-conception counselling, planned pregnancies and a tight management in expert centres applying a tailored treatment approach may have contributed to the favourable pregnancy outcomes.

BackgroundTo establish a register to determine disease activity, pregnancy surveillance and safety of medication during pregnancy and lactation, and monitoring this group as a quality register.MethodsThe Norwegian pregnancy register RevNatus is designed as a nation-wide, web-based longitudinal observational cohort study with 17 participating centres. Pregnant patients or patients planning a pregnancy with confirmed diagnosis of inflammatory rheumatic disease are eligible to be enrolled. The women are preferred enrolled before conception and with registrations each trimester, 6 weeks, 6 and 12 months postpartum. At baseline diagnosis, sociodemographic parameters, disease activity, anti-rheumatic medication, obstetric history, comorbidities and antibody status are reported. The register has been approved by the Norwegian Data Inspectorate and is run by The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases.ResultsFrom February 2016 – January 2018 597 women were included in RevNatus, mean age at inclusion was 30,8 (17–44). Among these patients 4% had only completed primary school, 24% secondary education and 72% had completed a university education. At inclusion 4% were smoking (general population 11%) and 6% used snuff (general population 12%). At registration 6 weeks after delivery 3% were smoking and 2% used snuff. Alltogether 346 women were registered with a control 6 weeks after delivery. Of these, 31 women experienced spontaneous abortion and one therapeutic abortion. Among the remaining, 314 had live born infants including 7 twin births and one triplet birth. Among the women with registration 6 week postpartum, 260 (75%) women were diagnosed with chronic inflammatory arthritis including rheumatoid arthritis, spondylarthritis, juvenile idiopathic arthritis and unspecified arthritis. Correspondingly, 79 (23%) women were registered with inflammatory connective tissue disease (SLE, MCTD, poly-dermato myositis, systemic sclerosis), 3 with vasculitic disease (Takayasu’s arteritis, Mb Behcet), and 5 with primary anti-phospholipid antibody (APS) syndrome. Mean disease duration (SD) for all diagnoses was 6,5 years.6,8 Corresponding, mean disease duration in women with RA was 6,7 (4,1) years, in women with SLE 9,4 (6,1) years and in women with JIA 20,7 (7,3) years. Mean gestational age at birth for all diagnoses was 38,7 (2,5) weeks. The gestational age was lowest in SLE women 37,9 (2,59) weeks. Mean gestational week for spontaneous abortion was at 11 weeks. Mean birthweight (SD) was 3268758,7 gram in offspring of women with RA and 3133 gram in women with SLE. Overall 71 (22%) women had caesarean deliveries, 14% were acute and 9% planned caesarean deliveries. Six weeks postpartum 258 women (82,7%) were breastfeeding their babies.ConclusionsThe Norwegian pregnancy register RevNatus was established to study the course and outcomes of pregnancies in women with inflammatory rheumatic diseases as well as increased knowledge on the use and safety of treatments during pregnancy and lactation. The results of t...

Background:Treat to target is a goal, also in pregnant women with Rheumatoid arthritis (1). There is increasing evidence on safe use with TNF inhibitors during pregnancy. Adjusted use of TNF inhibitors preconception and throughout pregnancy may stabilize disease activity and prevent flares (2). Low disease activity is also beneficial for the fetus.Objectives:To study the use of TNF-inhibitors among women with Rheumatic arthritis during and after pregnancy.Methods:RevNatus is a Norwegian, nationwide quality register that monitors treatment of inflammatory rheumatic diseases before, during and after pregnancy. Data from RevNatus in the period October 2017 to October 2019 was used to map the use of all types of TNF inhibitors among 208 women with rheumatoid arthritis, diagnosed by the ACR/EULAR criteria. The use of medication was reported at the time of visit in outpatient clinic. The frequency of use of TNF inhibitors registered at seven timepoints from pre-pregnancy to twelve months after delivery.Results:The use of medication was reported at each visit for all the women with rheumatoid arthritis. Most of the women were not using TNF inhibitors before and beyond conception. Most of the women continuing TNF inhibitors beyond conception used certolizumab or etanercept. Adalimumab and infliximab were used in pregnancy (tabell 1).Tabell 1.certoliz-umabetane-rceptadalim-umabgolim-umabinflixi-mabNo TNF-inhibitorBefore pregnancyn=10521% (22)9% (10)3% (3)1% (1)66% (69)1.trimestern=8119% (15)10% (8)71% (58)2.trimestern=8810% (9)10% (9)80% (70)3.trimestern=9111% (10)5% (5)83% (76)6 weeks post partum n=9622% (21)13% (13)1% (1)1% (1)63% (60)6 months post partum n=8824% (21)18% (16)4% (4)1% (1)53% (46)12 months post partum n=8421% (18)17% (15)7% (6)2% (2)53% (43)Conclusion:Most of the women with rheumatic arthritis were not treated with TNF inhibitors before or in pregnancy. Women with rheumatic arthritis that continuing treatment with TNF inhibitors through pregnancy were using certilozumab and etanercept.References:[1]Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. 2016;75(5):795-810.[2]van den Brandt S, Zbinden A, Baeten D, Villiger PM, Ostensen M, Forger F. Risk factors for flare and treatment of disease flares during pregnancy in rheumatoid arthritis and axial spondyloarthritis patients. Arthritis Res Ther. 2017;19(1):64.Disclosure of Interests:None declared

Background:Behçets disease (BD) is a complex and multisystemic disorder of unknown etiology. It is characterized by recurrent oral and genital ulcers and inflammatory eye involvement. It can also affect the cardiovascular, pulmonary and skeletal system. BD is commonly diagnosed in women in reproductive age. Pregnancy outcomes are reported in previous studies with discrepancies in the rate of pregnancy-related complications.Objectives:To describe the course of pregnancy in patients with BD.Methods:We prospectively collected data on pregnancy outcome in women with BD through the nationwide Norwegian registry on pregnancy and rheumatic diseases (RevNatus) from 2016-2020. All women were diagnosed with ICD-10 code M35.2. 13 pregnancies in 11 women were recorded. One women had two pregnancies including one twin birth.Results:Median age at conception was 30 years (range 25-32), with median disease duration 7 years (range 1-15). There were no serious organ manifestations. Tnf-alpha-inhibitors were used in 2nd trimester in 3 pregnancies. All pregnancies resulted in live births with median gestational age at delivery of 38 weeks (range 36-41). No preeclampsia or HELLP were recorded.Table 1. Pregnancy outcome in 13 BD pregnanciesPatient #Pregnancy #Medication at 2.nd trimesterOral or genital ulcers during pregnancyDisease activity during pregnancyCRP value at 2nd trimesterGestational age at delivery, weekMode of deliveryBirth weight, gramA1Azathioprine Colchicine LMWHnopersistent*1338SVD3475B2Adalimumab Colchicine LDPrednisolonyespersistent *440SVD3215C3noyespersistent*541SVD3355D4Adalimumab LDPrednisolonyespersistent*2336SVD1940E5Etanercept ASAno241SVD34106a (twin)Etanercept ASAno537Elective Sectio24006b (twin)2410F7LDPrednisolonyesflare**1538SVD31808Adalimumab LDPrednisolonyesflare**437Acute Sectio3049G9nonoremission***141SVD3150H10LDPrednisolonyespersistent *1038SVD2480I11ASAnopersistent*339SVD3410J12noyespersistent*137SVD3115K13Ciklosporinenoremission***337SVD3130SVD = spontaneous vaginal delivery, ASA = acetylsalicylic acid, LDPrednisolon = Low dose Prednisolon <10 mg/day, *= persistent throughout pregnancy, **= flare once during pregnancy, ***= remission throughout pregnancyConclusion:Pregnancies in women with BD in this cohort were uncomplicated. We did not reveal any serious events, and they all resulted in live births. However, BD is a very heterogeneous disease, and the women in our cohort did not have any serious organ manifestations. Larger cohorts representing the heterogeneity are needed to study the course and outcome of pregnancies in BD.Disclosure of Interests:None declared

BackgroundIt has been a tradition in Norway to admit patients with rheumatic diseases (RMDs) to rehabilitation in a warm climate for periods of 3- 4 weeks. Young adults with RMDs have to deal with life challenges such as; relating to friends, family and partners, education, establish a family, adjusting to working life, and handling physical and emotional changes, in addition to coping with their RMD. Since young adults may have different challenges and needs than older adults, we developed a 17 day intensive rehabilitation programme aimed at this age group. Two pilot groups with a total of 15 young adults with RMDs age 18–35 participated. The main interventions were intensive exercise (2–3/day), individual physiotherapy (daily), individual treatment plans, group interventions (daily) and patient education (daily). Climatotherapy was also a part of the intervention.ObjectivesThe aim of this study was to describe the perceptions and experiences of young patients with participating in a 17 day intensive warm climate rehabilitation program that was targeted, organized and adjusted to their age group.MethodsIn order to capture the patients' own experiences and perceptions of the rehabilitation program, a focus group interview was conducted six months after the end of the intervention (3 females, 2 men, age 27 - 35 years, disease duration 2 - 13 years, diagnosis: Juvenile Arthritis (1), Rheumatoid Arthritis (1) and Spondyloarthropathy (3)). The interview focused on topics related to the rehabilitation program, such as content and organization, confidence in the staffs' competence, possible effects on health and everyday life, significance of meeting other young adults, satisfaction/dissatisfaction with the programme and feasible negative aspects related to the intervention. Qualitative content analyses were used to make abstractions and categories.ResultsThe identified themes were “shared understanding”, “length of program”, “changes in daily life routine“, “high intensity” and “competence of healthcare providers'. Shared understanding of their life situation with the other group members was seen as an important component in the program. Sharing knowledge and personal experience with others who are in similar phases in life enhances learning was seen as a useful and positive way of providing self-management. Due to their phases of life, all the participants said that the length of the program was perfect. They could not have attended a traditionally four week program. The intensity of the exercise was higher than traditionally programs and suited the group. After the program they had made changes to their daily life routine both in exercise and diet, but they would like a form of organized follow up from a health care provider. All agreed that the physiotherapists provided an individual program with high intensity and adjusted programme suitable for the young group.ConclusionsThis qualitative study suggests that patients experience that their needs were met in this targeted rehabilitation program. The patients reported...