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Study Shows Improvement of Rheumatoid Arthritis During Pregnancy
June 20, 2007
Disease activity in patients with rheumatoid arthritis (RA) is
significantly reduced during pregnancy, according to new data presented
here the Annual European Congress of Rheumatology (EULAR).
In the study, RA improved significantly from the first
trimester to the third trimester of the participants' pregnancy and
this effect extended into the postpartum stage.
This is the first prospective study to confirm the relationship
between RA and pregnancy, tracking 124 female RA patients throughout
their pregnancy and at 6, 12 and 26 weeks postpartum. The RA
improvement was seen in 40% of patients. Furthermore, 64% of patients
remained relatively stable or improved postpartum. Only a third of
patients (36%) experienced flare-ups, 5% severely.
Dr Yaël de Man of Erasmus MC University Medical Center,
Rotterdam, The Netherlands, who performed this research, said: "Whilst
previous literature has suggested an improvement of RA in pregnancy,
this is the first prospective study to put a figure to this. The
percentage of patients experiencing flares was much lower than previous
studies, which we attribute to adequately-used DMARDs and biologicals
to suppress disease activity postpartum. It is also interesting to note
the existence of a complex interaction between female hormones during
pregnancy and the epidemiology of RA, which may contribute to the
development of new prevention and treatment approaches."
In the study, patients were assessed
according to medication use, the Disease Activity Score DAS28 and the
level of inflammation marker C-reactive protein (CRP). Disease activity
was calculated with DAS28-CRP with three variables (DAS28-CRP-3). The
change between the DAS28 at first and third trimester was used to
categorise patients according to the EULAR response criteria into good,
moderate and non-responders. The change between the DAS28 at 6 weeks
and 12 or 26 weeks postpartum was used to determine if a severe or
moderate flare was present.
The DAS28 decreased significantly during pregnancy from
3.7 (SD 1.1) in the first trimester to 3.4 (SD 1.1) in the third
trimester (n=124, P =.003). The mean DAS28 was 3.4 (SD 1.1) at six
weeks postpartum. During pregnancy, 11% (49/124) were good responders,
40% were at least moderate responders (49/124) and 60% (75/124) were
non-responders. The relapse of disease activity was present at twelve
weeks postpartum with a mean DAS28 of 3.7 (SD 1.2) and was slightly
lower at 26 weeks postpartum with a mean of 3.6 (SD 1.2).
Postpartum, 5% (5/110) had a severe flare, 36% (40/110)
had at least a moderate flare and 64% (70/110) remained relatively
stable or improved.
During all trimesters, the percentages of DMARDs used
were stable (sulfasalazine 32%, prednisone 35%, hydroxychloroquine 1%
and gold i.m 1%), whilst DMARD use rose considerably postpartum (57% at
the third trimester versus 82% post partum), mainly due to methotrexate
(44%) and biologicals (8%).
This study was supported by the Dutch Arthritis Association.
SOURCE: The European League Against Rheumatism
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