Background/Purpose: While overall SLE disease and lupus nephritis activity during pregnancy have been studied, the activity of inflammatory arthritis during SLE pregnancy has not been examined. Our goals were to evaluate the activity of inflammatory arthritis during pregnancy in SLE and its effects on pregnancy outcomes.

Methods: From our Registry of all patients seen in our Lupus Center with confirmed SLE by rheumatologist review for 1997 ACR Criteria for Classification, we identified women with >2 visits to our Center and ≥1 pregnancy between 1990-2013. From Registry and medical records, we collected data on: ages at SLE diagnosis and at pregnancy, history of inflammatory arthritis preceding and during pregnancy, SLE medications during pregnancy, and pregnancy outcomes. We analyzed the data using descriptive statistics and Fisher’s exact tests.

Results: Of 1,127 women with SLE, 56% had a history of inflammatory arthritis and 134 had ≥1 pregnancy (184 pregnancies). Among women with pregnancies, mean age at SLE diagnosis was 23.1 (SD 6.8) years; 61% were White, 14% Hispanic and 13% Black. Mean age at conception was 30.8 (SD 5.3) years; average SLE duration prior to pregnancy was 7.1 (SD 5.8) years; 9% were diagnosed with SLE during pregnancy; 33% were primigravida. Of the women without a history of inflammatory arthritis (n=80), none experienced arthritis during pregnancy. Of the 104 pregnancies in women with a history of inflammatory arthritis, 16 had active arthritis in the 6 months prior to conception (Table). Five of these women received an immunosuppressant 6 months prior to conception and 13 had medication changes during pregnancy. In 4 of 16 pregnancies with active arthritis prior to pregnancy, arthritis flared during pregnancy (25%), whereas arthritis flared in 6 of 88 pregnancies with no active inflammatory arthritis within 6 months of pregnancy (7%, p 0.045). Overall, 83% of arthritis flares occurred in the 2^nd trimester.

     Of the 16 pregnancies in which the mother had recently active inflammatory arthritis, 62% were term deliveries, 19% were pre-term, and 19% 1^st trimester abortions. Of the pregnancies with quiescent inflammatory arthritis 6 months prior to pregnancy, delivery outcomes were: 68% term, 17% preterm (p 0.73 vs. in those with arthritis), 10% 1^st trimester abortions, and 5% 2^nd or 3^rd trimester fetal loss (p 0.71 vs. in those with arthritis).

Conclusion: Inflammatory arthritis activity during pregnancy was uncommon in this female SLE population. Among women with inflammatory arthritis symptoms 6 months prior to conception, a higher proportion had persistent or worsened symptoms during pregnancy than among women whose inflammatory arthritis was inactive 6 months prior to conception. Pregnancy outcomes were similar among those with and without active inflammatory arthritis prior to pregnancy.

Table. Arthritis Activity in 104 Pregnancies among Women with a History of SLE Arthritis, 1990-2013
				Medications 6 months prior to Pregnancy
	Number of pregnancies	Age at pregnancy, mean (SD)	Arthritis during pregnancy, N (%)	Prednisone, N (%)	Immuno-suppressants*, N (%)	Hydroxy-chloroquine, N (%)	NSAID, N (%)
Arthritis active 6 months prior to pregnancy	16	29.8 (5.4)	4 (25)	8 (50)	5 (31)	10 (63)	7 (43)
History of arthritis, not active 6 months prior to pregnancy	88	30.9 (4.9)	6 (7)	31 (35)	11 (13)	44 (50)	12 (14)
*Immunosuppressants: azathioprine, mycophenylate mofetil, sulfasalazine, and rituximab. Not mutually exclusive categories.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inflammatory-arthritis-activity-during-pregnancy-in-systemic-lupus-erythematosus/