Background/Purpose: Psoriatic arthritis (PsA) often develops between the 3^rd -4^thdecades of life, including women of childbearing age.  However, little is known about PsA activity during pregnancy and the postpartum period. We aimed to evaluate joint and skin activity of PsA during pregnancy and “postpartum” period.

Methods: Patients with PsA are followed prospectively according to a standard protocol. Data are stored on a computerized database. Women who had pregnancies during follow up between 1990 and 2015 and at least one clinic visit during pregnancy were identified. “Postpartum” period was defined as up to 1 year after pregnancy. PsA activity was defined by 5 states: improvement, worsening (both defined as a change in at least 2 active joints), stable low (defined as 0 or 1 active joint), stable high (defined as ≥ 2 active joints) or a combination of improvement and worsening. Skin activity was defined by 5 states: improvement, worsening (both defined as a change of 1 in the psoriatic area severity index (PASI), stable low (PASI<2), stable high (PASI ≥2) or a combination of improvement and worsening.

Results: 29 PsA women with 42 pregnancies were identified. Of the 42 pregnancies 38 (90%) resulted in live healthy babies, 2 in miscarriages (at the end of the 1^sttrimester) and 2 are still pregnant. The mean age at pregnancy was 33.8 ± 4.6. The mean PsA duration was 12 ± 7.4 and the mean psoriasis duration was 19 ± 8.9 years. The mean damaged joint count was 6.3 ± 11.2 and the mean Stienbrocker score was 2 ± 5.5. The majority (24, 58.5%) of pregnancies had either PsA improvement or stable low disease activity, while 13 (31.7%) had either worsening or stable high disease activity (table 1). During the “postpartum” period, 22 (55%) had either improvement or stable low PsA disease activity, while 18 (45%) had either worsening or stable high disease activity. The skin activity during pregnancy had either improved or stayed in a stable low state in 30 (88.3%), worsened in 3 (8.8%) and initially improved with following worsening in 1 pregnancy (table 1). The skin activity during the “postpartum” period had either improved or stayed in stable low in 15 (42.9%) pregnancies, or worsened in 20 (57.1%). During pregnancy, 17 (40.5%) used NSAIDS, 18 (42.9%) used DMARDS, 7 (16.7%) used biologic treatment (6 used anti TNFα agents and 1 Ustekinumab). 

Table 1: Joints and skin activity during pregnancy and “postpartum” period

Conclusion: The outcome of pregnancy among patients with PsA is excellent. Disease activity in both skin and joints is variable with the majority (60%) improving during pregnancy but worsening in the “postpartum” period.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/psoriatic-arthritis-activity-during-pregnancy-and-the-postpartum%ef%bf%bd-period/