Identifying Clinical Factors Associated With Low Disease Activity and Remission of Rheumatoid Arthritis During Pregnancy

Abstract

Objective. To identify a combination of clinical factors associated with low disease activity and remission in the third trimester during pregnancy in women with rheumatoid arthritis (RA).Methods. This study is embedded in the Pregnancy-Induced Amelioration of Rheumatoid Arthritis study, a prospective cohort study. There were data available on 190 pregnancies from first trimester until delivery. Multivariate regression analyses were performed on the disease activity (Disease Activity Score in 28 joints [DAS28] using the C-reactive protein [CRP] level) in the third trimester. Independent covariates were the DAS28-CRP-3 in first trimester, prednisone and sulfasalazine use in the first trimester, parity, methotrexate use in the past, autoantibody status, the presence of erosions, and RA disease duration. Results. In multivariate regression models, the DAS28-CRP-3, use of prednisone in the first trimester, and the presence of autoantibodies were negatively associated with low disease activity (DAS28-CRP-3 <3.2) in the third trimester (P < 0.05), and the DAS28-CRP-3 and presence of autoantibodies were also associated with remission (DAS28-CRP-3 <2.6) (P < 0.001). Subgroup analysis revealed that the associations of prednisone use and presence of autoantibodies were only present in patients with moderate-to-high disease activity (DAS28-CRP-3 ‡3.2) in the first trimester. Conclusion. RA patients who have a low DAS28-CRP-3 in the first trimester (irrespective of autoantibody status or prednisone use) are likely to have low disease activity or remission in the third trimester. Also, women with higher disease activity who are not taking prednisone and who express no autoantibodies still have a fair chance of low disease activity in the last trimester.

No Association of Discontinuing Tumor Necrosis Factor Inhibitors Before Gestational Week Twenty in Well‐Controlled Rheumatoid Arthritis and Juvenile Idiopathic Arthritis With a Disease Worsening in Late Pregnancy

“…However, the fact that the time TNFi were stopped in that study was on average earlier in gestation compared to the women in our sample indicates that the timing of drug discontinuation during pregnancy may be of importance. Moreover, the authors also showed an association of flares during pregnancy with elevated disease activity in early pregnancy, a finding that was confirmed by others (). In contrast, studies of nonpregnant patients with RA have demonstrated that low disease activity at the time of TNFi discontinuation is a predictor of maintained benefit .…”

Altered DNA methylation in children born to mothers with rheumatoid arthritis during pregnancy

“…This study is embedded in the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study, a prospective cohort study on pregnancy and RA 29. From 2002 to 2008, 369 female patients with RA who had a wish to conceive (or already pregnant) were enrolled 30 31. After participation in the PARA study, 196 children and their parents were invited to participate in a follow-up study, the FEtal Programming in Rheumatoid Arthritis (FEPRA) study.…”

“…In the PARA study, data on mother (eg, disease activity (with the Disease Activity Score in 28 joints using C reactive protein levels, DAS28-CRP 3 )) and child were collected 31. For the FEPRA study, data on blood pressure, growth and body composition of the children were measured.…”

The new FDA labeling rule: impact on prescribing rheumatological medications during pregnancy

“…Unfortunately, there is no clear predictor of remission, other than seronegative status [24]. Other studies have suggested that disease activity pre-conception or in early pregnancy can predict flare during pregnancy [25,26]. Although there does not appear to be an increased risk for congenital malformations as a result of RA itself, the presence of RA itself can influence the course of pregnancy.…”