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Despite the folklore, not all women with arthritis who become pregnant will improve or go into remission. Recent studies have suggested that up to one-third of RA patients will flare during pregnancy.
This issue has been further examined in a cohort of 136 pregnant patients with RA and axial spondyloarthritis (axSpA) who were prospectively followed before, during, and after pregnancy.
During pregnancy flares occurred in 29% of RA patients and in 25% of SpA patients.
In RA patients, 15/75 discontinued their tumor necrosis factor inhibitor (TNFi) at the time of a positive pregnancy test, with a nearly 3 fold increased the risk for flare (RR 3.33 (95% CI 1.8-6.1).
Flares were managed with either TNFi or glucocorticosteroid (GC) treatment and yielded improvement in 60%.
Of 61 patients with axSpA, 24 patients were on TNFi and discontinued the treatment at the time of the positive pregnancy test. In axSpA stopping TNFi, also increased the risk of flare (RR 3.08 (95% CI 1.2-7.9).
Patients with axSpA without TNFi in the preconception period showed persistent high disease activity from prepregnancy until the postpartum period.
These data speak to the need for ongoing TNFi therapy in a subset of patients with RA and axSpA beyond conception.