Tuesday, 16 Jul 2019

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Update on Pregnancy Management in RA

Two recent reports offer good news to rheumatoid arthritis (RA) women who are planning to become pregnant. 

The first studies, RA women experiencing fertility issues who turn to assisted reproductive technology (ART) shows that live births were significantly lower in women with rheumatoid arthritis receiving ART treatment compared to usual rates in women without rheumatoid arthritis.

A nationwide Danish health registries, studied 1149 embryo transfers in RA women and 198 941 embryo transfers in control women. The adjusted OR (aOR) for a live birth in an RA patient was 0.78 (95% CI 0.65 to 0.92). Corticosteroid prescription prior to embryo transfer increased the OR for live birth (aOR=1.32 (95% CI 0.85 to 2.05)).

These result suggested that the problem was related to an impaired chance of embryo implantation that may be corrected by corticosteroid use before ART, but the latter merits further research.

The second study from OTIS researchers demonstrated in women with RA and JIA who discontinue their  TNF inhibitor (TNFi) before gestational week 20, was associated with with well‐controlled disease.  (Citation source: https://buff.ly/2HIjIzB

From a study of 490 women (397 with RA, 93 with JIA), 25% discontinued a TNFi before gestational week 20, and 41% used a TNFi beyond week 20 and 34.1% did not use a TNFi during pregnancy. At the time of enrollment, disease activity was low to minimal in 72.9% of women.

TNFi discontinuation was not associated with a clinically important worsening of patient reported outcome measures at the third trimester. Although there was a trend towards third trimester improvement with continued TNFi use (beyond week 20), this was not significant in multivariate analysis.

Although data was collected on birth outcomes, it was not included in this report.

The author has no conflicts of interest to disclose related to this subject

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