Disease activity during Pregnancy in Rheumatoid arthritis and Spondyloarthritis Save

A prospective French study of rheumatoid arthritis (RA) or spondyloarthritis (SpA) patients showed that most maintained stable disease activity during pregnancy, but over one-third flared and required major changes in treatment.

The aim of this study was to analyze disease activity and relapse during pregnancy in women with RA and SpA.  Data was drawn from the multicentre prospective GR2 study that enrolled consecutive pregnant women with RA or SpA (between 2014 to 2022) who had at least two prenatal visits (including one in the first trimester). 

Among the 124 women included, 53 had RA and 71 had SpA. Overall, disease activity indexes remained stable in the 1st, 2nd and 3rd trimesters. However: 

• Disease relapse during pregnancy occurred in 17 (32%) RA patients and 28 (39%) SpA patients, among whom 30 (24%) requiring a treatment intensification.
• 18 (35%) RA and 44 (62%) SPA received a TNF inhibitor during pregnancy 

Predictors of disease relapse during pregnancy (multivariable analysis): 

• Nulliparity (odds ratio, OR: 6.5, 95%CI: 1.1 to 37.9) a
• Disease RA flare in the 12 months prior to conception (OR: 8.2, 95%CI: 1.6 to 42.7) 
• History of bDMARD use (OR: 5.4, 95%CI: 1.1 to 27.3) in SpA patients.

While disease activity remained stable for most, there is a significant risk of relapse and escalated therapy in RA and SpA patients who become pregnant.