Background/Purpose: Patient-reported measures of disease activity may provide useful adjuncts to physician-reported measures in identifying pregnancies at greater risk for adverse pregnancy outcomes. Little is known about the utility of these measures in SLE patients, and most analyses in patients with RA use only a single measure of disease activity or disability.

Methods: Data on pregnancy outcomes were collected on 225 patients with SLE or RA enrolled in a prospective registry at a single academic center from 2008-2016. Disease activity was measured by physician global assessment (PGA) in SLE and RA, as well as joint counts in RA. The primary patient-reported measure used was the Health Assessment Questionnaire (HAQ); we also tested the utility of pain and general health visual-analog scales. Univariate and multivariable regression models adjusted for race, education, living status, and BMI were used to assess the relationship between patient and physician-reported measures of disease activity and adverse pregnancy outcomes.

Results: Among 145 women with SLE, the mean age was 30 and 50% were African American. Among the 80 women with RA, mean age was 33; nearly 80% were white. Women with RA were more likely to be living with a spouse or partner (85% vs 68%) and were more likely to have completed at least 4 years of college (75% vs 52%). Nearly 50% of women with lupus were Ro+, and 17% percent had a history of lupus nephritis.

In women with RA, patient-reported disease activity was associated with preterm birth (OR 5.9 (95% CI: 1.5-23.9)), and gestational age (beta -1.5 weeks (-2.6, -0.4)). In addition, physician assessment of disease activity predicted preterm (OR 2.1 (1.2-3.5)) and small for gestational age births (OR 1.8 (1.03-3.1), and gestational age in weeks (beta -0.6 weeks (-0.9, -0.02)). On the other hand, for women with SLE, patient-reported measures, including HAQ, pain and global health, were not associated with adverse pregnancy outcomes. However, physician’s global assessment was associated with preterm birth (OR 2.9 (1.-6.3)), C-section delivery (OR 2.3 (1.0-5.3)), and preeclampsia (OR 2.8 (1.3-6.3)) in SLE patients. The results do not appear to be driven by nephritis or aPL syndrome.

Conclusion: Patient-reported measures of disease activity in RA patients may provide useful adjuncts for physicians to identify pregnancies at higher risk for adverse events. This suggests that increased activity on a patient-reported measure should prompt action during an RA pregnancy. In contrast, in SLE, while the physician-reported measures correlated with pregnancy outcome, the patient-reported measures did not. Our findings provide additional support for the use of patient-reported measures among women with inflammatory arthritis in pregnancy and impetus for the development of patient-reported measures that more accurately reflect lupus disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-reported-disease-activity-and-adverse-pregnancy-outcomes-in-systemic-lupus-erythematosus-and-rheumatoid-arthritis/