Background/Purpose: It is recognised that active disease in women with inflammatory arthritis is associated with adverse pregnancy outcomes. Most studies however, have focussed upon patients with rheumatoid arthritis and there is much less information on pregnancy outcomes in patients with psoriatic arthritis (PsA). Therefore, we present the outcomes of pregnancy in 14 consecutive patients, seen in a specialised obstetric rheumatology clinic – dealing with pregnancy issues in patients with rheumatic disease – over a 7-year period to explore the relationship between PsA and pregnancy.

Methods: Consecutive patients with PsA referred to the obstetric rheumatology clinic at University College London Hospital(UCLH) 2008-2014 were identified retrospectively. Their medical records six months before, during and four months after pregnancy were then examined to record: PsA disease activity, using physician global activity; medication history; plus maternal and fetal outcomes.

Results: Fourteen patients, with 16 pregnancies, were identified. Age range at delivery was 28-43 (median 34) years. Eleven had peripheral PsA; 3 had axial spondyloarthropathy and psoriasis. Previous obstetric history included 3 miscarriages and 10 live births in 8 patients. Pre-pregnancy, PsA related disease activity was: mild in 10; moderate in 2; and severe in 2 patients.  Therapy pre-pregnancy included: NSAIDs alone, 4 patients; sulfasalazine (SSZ) ± prednisolone, 3 patients; anti-TNFα inhibitors ± SSZ, 8 patients; leflunomide (LEF), which was stopped and washed out pre-partum, 1 patient; and no patients on methotrexate. In line with previous recommendations, anti-TNFα was stopped during the first trimester of pregnancy. During pregnancy disease activity improved in 1 patient, remained active in 2 and worsened in 5 patients during mid to late pregnancy. In two cases this was managed with a reducing dose of prednisolone, from 20mg/day; in two other cases both prednisolone and SSZ were started. Of 16 pregnancies there were 2 spontaneous first trimester miscarriages, 14 live births and no maternal complications. Data from 11 births at UCLH revealed: mean birth weight 3.2 (range 2.9-3.8) kg; mean gestation 39.5 (range 37 to 42) weeks; 8 vaginal deliveries; 2 elective and 1 emergency caesarean section; and no congenital malformations. In 8 patients disease activity increased post-partum and was managed with reducing does of prednisolone or by restarting anti-TNF therapy. Of patients who flared, two had active disease activity antenatally which did not improve with pregnancy and the rest flared during/after pregnancy.

Conclusion: Pregnancy outcomes in these patients with PsA did not display an appreciable increase in miscarriage rate or pre-term delivery. Increased disease activity however, occurred in 5/14 patients during and 8/14 within four months post-pregnancy requiring an increase in disease specific therapy. Knowledge of alterations of disease activity in relation to pregnancy is important when counselling patients with PsA in this situation and advising continuation of disease ameliorating therapies that are compatible with pregnancy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-in-psoriatic-arthritis-a-case-series/