The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

Berman, Mark; Zisman, Devy; Wollman, Jonathan; Levartovsky, David; Rimon, Ephraim; Elkayam, Ori; Paran, Daphna

doi:10.3899/jrheum.171218

Cited by 27 publications

(18 citation statements)

References 16 publications

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“…A recent retrospective study found no significant change in PsA disease activity during pregnancy, but a statistically significant aggravation was observed during the postpartum period compared with the third trimester (n = 33 live births; p = .01; Berman et al, 2018). Similarly, in a prospective multicenter study including 103 women with PsA (n = 108 pregnancies) from a Norwegian nationwide register, PsA disease activity decreased during pregnancy and increased within 6 months postpartum (Ursin et al, 2018).…”

Section: Psoriasis and Pregnancymentioning

confidence: 93%

“…On the other hand, discontinuation of biologic treatment before pregnancy or during the first trimester (n = 15 of 21 pregnancies) was associated with significant disease worsening during pregnancy and in the postpartum period (odds ratio: 7; 95% CI, 0.5-98.6), but no significant changes were reported in the small number of patients who continued on biologic therapy beyond the first trimester (n = 6; anti-tumor necrosis factor [anti-TNF]: n = 5; ustekinumab: n = 1; Berman et al, 2018). In line with these findings, although only a small number of women with PsA used anti-TNFs during pregnancy (n = 7) in the Norwegian study, disease activity 6 months postpartum was significantly lower in this group (mean DAS28-C-reactive protein with anti-TNF: 2.22 vs. without anti-TNF: 2.72; p = .043; Ursin et al, 2018).…”

Section: Psoriasis and Pregnancymentioning

confidence: 99%

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Clinical considerations for the management of psoriasis in women

Gottlieb

Ryan

Murase

2019

International Journal of Women's Dermatology

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The burden of psoriasis is particularly high for women, who report lower levels of happiness (women: 18.5%; men: 11.3% lower vs. general population) and are more likely to experience stress (women: > 60%; men: 42%), loneliness (women: 25-28%; men: 19-24%), stigmatization (Feelings of Stigmatization Questionnaire score; women: 93.2; men: 78.0), and reduced sexual activity (women: 33%; men: 19%) compared with men. The onset of psoriasis is bimodal, with one incidence peak (15-30 years) that coincides with the prime reproductive age for women, which poses specific challenges for their treatment. However, well-established guidelines for the treatment of women of childbearing age are lacking. Many women experience stabilization (21%) or improvement (55%) of their skin during pregnancy, but up to a quarter can experience disease worsening, and postpartum flares are common (> 50%). Therefore, balancing the risk of treatment with the risk of uncontrolled disease is important. Because half of pregnancies are unplanned, the implications of therapeutic options must be considered for all women with psoriasis who are sexually active, irrespective of intentions to start a family. Timely initiation of these discussions by health care professionals is paramount to prevent unintentional toxicity to the developing fetus. For example, acitretin, methotrexate, and oral psoralen/ultraviolet A are all contraindicated in pregnancy. Reassuringly, safety data for other psoriasis treatments during pregnancy are increasingly available, particularly for anti-tumor necrosis factor therapies. Despite encouraging data from pregnancy exposure registries and clinical studies now being included in anti-tumor necrosis factor drug labels, comfort with prescribing these therapies to pregnant women remains low (U.S. dermatologists: 21%; EU-5 dermatologists: 10%). In this article, we review issues specific to treating women of childbearing age with psoriasis and highlight the need for treatment guidelines to ensure consistent care and optimal outcomes for these patients.

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Section: Psoriasis and Pregnancymentioning

confidence: 93%

Section: Psoriasis and Pregnancymentioning

confidence: 99%

Clinical considerations for the management of psoriasis in women

Gottlieb

Ryan

Murase

2019

International Journal of Women's Dermatology

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“…There is evidence that SLE becomes more severe during pregnancy and in the postpartum period [ 9 ]. Similarly, symptoms of psoriatic arthritis (PsA) worsen as well [ 10 , 11 ]. It has been established that discontinuing effective biologic treatment before a planned pregnancy leads to exacerbation of PsA during pregnancy and puerperium.…”

Section: Autoimmune Disease and Pregnancymentioning

confidence: 99%

“…It has been established that discontinuing effective biologic treatment before a planned pregnancy leads to exacerbation of PsA during pregnancy and puerperium. Therefore Berman et al recommend considering continuing biologics during pregnancy [ 11 ].…”

Section: Autoimmune Disease and Pregnancymentioning

confidence: 99%

The exposure to biologic and targeted synthetic disease-modifying antirheumatic drugs in pregnancy and lactation

Góralczyk

Kolossa

Waszczak-Jeka³

et al. 2020

pdia

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Chronic inflammatory diseases often affect women of childbearing age. Since biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) are more available, their use during conception, pregnancy and lactation has become a matter of concern. Current studies prove the safety of innovative therapy in pregnant women and may contribute to its wider use than before in pregnancy and lactation. It mainly concerns tumour necrosis factor α (TNF-α) inhibitors. We searched PubMed using Medical Subject Headings (MeSH) terms and identified relevant studies and guidelines. We present up-to-date knowledge of bDMARDs and tsDMARDs safety in pregnant and breastfeeding women.

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“…In the psoriatic arthritis cohort, the postpartum flare rate is 28-55%, and in keeping with the Norwegian (Revnatus) data, this seems to be highest at 6 months postpartum. As in the spondyloarthritis group, flare rates are associated with stopping anti-TNF early [12][13][14].…”

Section: Postpartum Flaresmentioning

confidence: 99%

Postnatal Care of Woman with Rheumatic Diseases

Mouyis

2020

Adv Ther

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Caring for women in the postnatal period can be challenging. One of the most important aspects is ensuring disease control as there is a risk of flare in the postpartum period. Other aspects of care also need to be addressed with the mother in mind such as breastfeeding or with the neonate in mind such as vaccinations or complications of the maternal condition affecting the neonate. This article highlights aspects of care that need to be addressed in the postpartum period such as flare rates, maternal wellbeing, thromboembolism, vaccinations, contraception and breast feeding.

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The Effect of Pregnancy on Disease Activity in Patients with Psoriatic Arthritis

Abstract: Continuation of biologics therapy was associated with a low level of disease activity and a low probability of flare during pregnancy. Stopping treatment with biologics before pregnancy is associated with flare during pregnancy and the postpartum period.

Cited by 27 publications

References 16 publications

Clinical considerations for the management of psoriasis in women

Clinical considerations for the management of psoriasis in women

The exposure to biologic and targeted synthetic disease-modifying antirheumatic drugs in pregnancy and lactation

Postnatal Care of Woman with Rheumatic Diseases

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