ICYMI: Psoriatic Arthritis and Pregnancy Save

Editor’s note: this article originally appeared on March 20, 2023, and it’s being shared again as we highlight PsA lectures from RheumNow Live 2023 during Tuesday Night Rheumatology this week.

Christina Chambers, PhD, MPH delivered a standout lecture on psoriatic arthritis and pregnancy on Saturday, the first day of RheumNow Live 2023.

Dr. Chambers, an epidemiologist at the University of California San Diego and the principal investigator of MotherToBaby Pregnancy Studies, reviewed the available data on psoriatic arthritis and pregnancy, which is relatively small. There is little evidence at this time that pregnancy affects psoriatic arthritis, though studies reliably demonstrate increase in disease activity in the post-partum period in both skin and joint disease.

In addition to understanding how pregnancy affects rheumatic disease, we must also understand the impact of psoriatic arthritis on maternal and fetal health. Patients with psoriatic arthritis do not have increased risk for gestational diabetes, low birth weight, and small for gestational age infants (<10% percentile size). There is, however, evidence of increased risk for pre-eclampsia, Caesarian section delivery, and conflicting data on pre-term delivery. The evaluation of patients with psoriatic arthritis is challenging due to the frequency of co-morbid conditions including obesity, pre-gestational hypertension and diabetes, and smoking compared to the general population, in addition to factors regarding their disease activity and medical treatments. 

Many of our biologic agents for psoriatic arthritis have limited data in pregnancy. Dr. Chambers recommended education and shared decision making with patients about risks and benefits and careful assessment of disease activity. Medication management should be utilized in patients depending on these shared decisions, and close attention is warranted to avoid the risk of post-partum flare. Dr. Chambers recommended using the MotherToBaby Fact Sheets and LactRx for further resources for autoimmune disease management during pregnancy and lactation.