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Abstract Number: 397

Does Elevated Disease Activity Or Medication Use Influence The Bone Density Of The Prepubertal Offspring In Pregnant Women With Rheumatoid Arthritis?

Florentien D.O. de Steenwinkel1, Anita C.S. Hokken-Koelega2, Johanna Hazes3 and Radboud J.E.M. Dolhain1, 1Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands, 2Pediatrics, Subdivision of Endocrinology, Erasmus Medical Center- Sophia Children's Hospital, Rotterdam, Netherlands, 3Department of Rheumatology, Erasmus Medical Center, Rotterdam, Netherlands

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: bone disease, prednisolone, prednisone, pregnancy and rheumatoid arthritis (RA)

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Session Information

Title: Rheumatoid Arthritis - Clinical Aspects I: Comorbidities in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Elevated rheumatoid arthritis disease activity and prednisone use during pregnancy  are both associated with a lower bone mineral density (BMD) of the patients, but both can be inevitable in pregnant women with RA. It is unknown if these variables influence the BMD of their offspring. Our purpose was to investigate whether medication or disease activity during pregnancy in patients with RA, influence the BMD of their prepubertal offspring

Methods:

Children were included if their mother participated in a prospective cohort study on RA and pregnancy. In 108 children, approximately 7-years-old, the BMD was assessed by dual-energy X-ray absorptiometry. The bone mineral density was expressed in standard deviation score (SDS) for total body and lumbar spine. Variables of the child known to influence the BMD were taken into account: calcium intake, physical activity, serum 25-hydroxyvitamin D, gender, length and weight. Pre- and postnatal variables known to influence the BMD are gestational age, maternal smoking, birth weight, postnatal tempo of growth and type of feeding. The independent variables were prednisone, sulfasalazine and RA disease activity during pregnancy.

Results:

The mean BMD total body SDS was -0.11 (0.10) and the mean BMD lumbar spine SDS was -0.20 (0.99). Both variables were comparable to zero, thus the mean of aged and sexed matched healthy controls. No association was found between prednisone or RA disease activity during pregnancy and BMD of 7-years-old offspring, even after correcting for all known associated variables. Sulfasalazine had a positive effect on the whole body BMD (difference in SDS=0.53; p=0.005).

Conclusion:

Neither elevated RA disease activity nor medication use during pregnancy is associated with a lower BMD of the 7-year-old offspring. The results of this study may be a help in balancing the risk and benefits of prescribing medication during pregnancy versus accepting active disease.


Disclosure:

F. D. O. de Steenwinkel,
None;

A. C. S. Hokken-Koelega,
None;

J. Hazes,
None;

R. J. E. M. Dolhain,
None.

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