Background
Methods
Patients and medications
Assessments and definitions
Statistical analysis
Results
Flare rates during pregnancy in patients with RA and axSpA are associated with active disease and TNFi discontinuation in early pregnancy
RA (n = 75) | axSpA (n = 61) | |
---|---|---|
Age at conception, years (median) | 31 (21–40) | 31 (22–41) |
Age at diagnosis, years (median) | 27 (20–38) | 24 (17–33) |
Rheumatoid factor-positive | 50 (66) | – |
HLA-B27-positive | – | 43 (70.5) |
axSpA with peripheral arthritis | – | 27 (44.3) |
Medication within 3 months before conception | ||
Methotrexatea
| 2 (2.7) | – |
NSAIDs | 8 (10.7) | 18 (29.5) |
TNFib
| 15 (20.0) | 24 (39.3) |
Glucocorticosteroidsc
| 25 (33.3) | 5 (8.2) |
DMARDs | 29 (38.7) | 5 (8.2) |
SSZ | 18 (24.0) | 5 (8.2) |
HCQ | 8 (10.7) | |
SSZ and HCQ | 3 (4.0) |
RA | axSpA | |||
---|---|---|---|---|
TNFi until positive pregnancy testa (n = 15) | TNFi-negative (n = 60) | TNFi until positive pregnancy test (n = 24) | TNFi-negative (n = 37) | |
Patients (n) with flare at | ||||
First trimester | 6 | 4 | 1 | 2 |
Second trimester | 3 | 4 | 5 | 1 |
Third trimester | 1 | 4 | 4 | 2 |
Medication at conception | ||||
TNFi | 15 (100) | 0 (0) | 24 (100) | 0 (0) |
NSAIDs | 1 (6.7) | 13 (21.7) | 11 (45.8) | 23 (61.2) |
Glucocorticosteroidsb
| 1 (6.7) | 23 (38.3) | 2 (8.3) | 1(3.7) |
DMARDs | 2 (13.3) | 27 (45) | 3 (12.5) | 2 (5.4) |
SSZ | 1 (6.7) | 17(28.3) | 3 (12.5) | 2 (5.4) |
HCQ | 1 (6.7) | 7 (11.7) | ||
SSZ and HCQ | 3 (5) | |||
Medication during pregnancy | ||||
TNFi | 4 (26.7) | 5 (8.3) | 10 (41.7) | 1 (2.7) |
NSAIDs | 5 (33.3) | 23 (38.3) | 15 (62.5) | 27 (73) |
Glucocorticosteroidsb
| 7 (46.7) | 29 (48.3) | 12 (50.0) | 3 (8.1) |
DMARDs | 7 (46.7) | 38 (63.3) | 3 (12.5) | 2 (5.4) |
SSZ | 1 (6.7) | 23 (38.3) | 3 (12.5) | 2 (5.4) |
HCQ | 1 (6.7) | 9 (15) | ||
SSZ and HCQ | 5 (33.3) | 6 (10) | ||
Initiation of medication during pregnancy | 9 (60) | 16 (26.7) | 15 (62.5) | 4 (10.8) |
TNFic
| 4 (26.7) | 5 (8.3) | 10 (41.7) | 1 (2.7) |
Start at visit 1 T-2 T-3 T | 2-2-0 | 1-3-1 | 4-4-2 | 0-0-1 |
Glucocorticosteroidsb
| 5 (33.3) | 11(18.6) | 12 (50) | 3 (8.1) |
Start at visit 1 T-2 T-3 T | 0-4-1 | 3-6-2 | 4-5-3 | 0-2-1 |
Patients with RA (n = 75) | Patients with axSpA (n = 61) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Flare | No flare | RR | 95% CI |
P value | Flare | No flare | RR | 95% CI |
P value | |
Treatment | ||||||||||
TNFi before pregnancya and discontinued at positive pregnancy test | 10 of 22 (45.5) | 5 of 53 (9.4) | 3.333 | (1.8–6.1) | 0.001* | 10 of 15 (66.7) | 14 of 46 (30.4) | 3.083 | (1.2–7.9) | 0.017* |
TNFi during first trimester | 3 of 22 (13.6) | 5 of 53 (9.4) | 1.322 | (0.5–3.5) | 0.686 | 6 of 15 (40) | 12 of 46 (26.1) | 1.593 | (0.7–3.8) | 0.340 |
GCs before pregnancy | 8 of 22 (36.4) | 17 of 53 (32.1) | 1.143 | (0.6–2.4) | 0.790 | 1 of 15 (6.7) | 4 of 46 (8.7) | 0.800 | (0.1–4.9) | 0.642 |
GCs during first trimester | 8 of 22 (36.4) | 17 of 53 (32.1) | 1.143 | (0.6–2.4) | 0.790 | 1 of 15 (6.7) | 6 of 46 (13) | 0.551 | (0.1–3.6) | 0.178 |
DMARDs before pregnancy | 10 of 22 (45.5) | 22 of 53 (41.5) | 1.120 | (0.6–2.3) | 0.801 | 3 of 15 (20) | 5 of 46 (10.9) | 1.656 | (0.6–4.6) | 0.589 |
DMARDs during first trimester | 8 of 22 (36.4) | 22 of 53 (42.5) | 0.860 | (0.4–1.8) | 0.798 | 2 of 15 (13.3) | 3 of 46 (6.5) | 1.723 | (0.5–5.6) | 0.589 |
NSAIDs before pregnancy | 2 of 22 (9.1) | 6 of 53 (11.3) | 0.838 | (0.2–2.9) | 0.568 | 3 of 15 (20) | 15 of 46 (32.6) | 0.597 | (0.2–1.9) | 0.518 |
NSAIDs during first trimester | 3 of 22 (13.6) | 6 of 53 (11.3) | 1.158 | (0.4–3.1) | 0.716 | 3 of 15 (20) | 15 of 46 (32.6) | 0.597 | (0.2–1.9) | 0.518 |
Disease activity | ||||||||||
Active disease before pregnancya
| 5 of 22 (22.7) | 9 of 53 (17.0) | 1.282 | (0.6–2.9) | 0.536 | 2 of 15 (13.3) | 4 of 46 (8.7) | 1.410 | (0.4–4.8) | 0.630 |
Active disease during first trimester | 8 of 22 (36.4) | 10 of 53 (18.9) | 0.456 | (0.2–0.9) | 0.038* | 5 of 15 (33.3) | 11 of 46 (23.9) | 0.717 | (0.3–1.7) | 0.510 |
Elevated CRP before pregnancya
| 3 of 22 (13.6) | 8 of 53 (15.1) | 0.584 | (0.3–1.3) | 0.282 | 1 of 15 (6.7) | 2 of 46 (4.3) | 0.724 | (0.1–3.8) | 0.718 |
Elevated CRP during first trimester | 9 of 22 (40.9) | 12 of 53 (22.6) | 0.553 | (0.2–0.7) | 0.008* | 7 of 15 (46.7) | 6 of 46 (13) | 0.280 | (0.1–0.7) | 0.006* |