Pregnancy Outcomes in Psoriatic Arthritis Save

A UK retrospective study published in the Journal of Rheumatology examined the pregnancy course and outcomes of women with psoriatic arthritis (PsA).  Compared to rheumatoid or lupus patients, there is far less known about the effects of pregnancy in those who have psoriatic disease.

They examined the effect of pregnancy on PsA disease activity and the effect of PsA on pregnancy outcomes in 14 consecutive PsA patients (16 pregnancies) referred to the obstetric rheumatology over a 7 year period.

Ten pre-pregnancy patients of the total 14 patients had mild disease activity, with 4 patients having moderate and severe disease activity.

Of the 10 patients with mild disease activity prior to pregnancy, 4 had worsening disease activity during pregnancy and 4 postpartum.

Of the 4 patients with moderate and severe disease activity at the start of pregnancy, all continued to have ongoing active disease during pregnancy and postpartum.

Overall, disease activity worsened through pregnancy such that 8/14 patients (57%) in both the second or third trimester and 10/14 patients (71%) within the first 4 months of postpartum had moderate and severe disease activity compared with only 4/14 patients (29%) pre-pregnancy.

Anti-TNF-α therapy was continued until the end of the first trimester in all 8 patients treated with anti-TNF-α. During pregnancy, 3 patients started receiving oral prednisone to alleviate arthritis flare.

Pregnancy outcomes were available in 11/16 pregnancies and included 2 first trimester miscarriages and 14 live births. There were no congenital malformations. The 11 live births at UCLH had mean gestation of 39.5 weeks (37–42 weeks) and mean birth weight of 3.2 kg (2.9–3.8 kg).

The authors found that PsA worsens during pregnancy and postpartum, and stressed the importance of preconception counseling and advising the patient about continuation of safe DMARD therapies during pregnancy when needed..