Rheumatoid Arthritis Activity During Pregnancy And Postpartum: Clinical Observations

Abstract

Rheumatoid arthritis (RA) frequently affects women of reproductive age, which underscores the importance of studying the interplay between pregnancy and RA. Historically, early observations noted a decrease in RA activity in the majority of pregnant women. More recent prospective studies report that only 48–66% of pregnant women experience clinical improvement during gestation, while postpartum exacerbations occur in approximately 70% of patients, often necessitating pharmacological intervention.

The aim of this study was to evaluate RA activity dynamics using DAS28–CRP during pregnancy and up to 12 months postpartum, to assess the impact of disease activity at conception on subsequent RA course, and to determine the necessity and effect of anti-inflammatory therapy during gestation.

In a prospective follow-up, 32 pregnancies in 29 women with confirmed RA (ACR 1987 criteria) were monitored. During pregnancy, 46% of patients demonstrated a decrease in disease activity. Postpartum, 75% experienced RA exacerbations, typically 1.5 months after delivery. Patients with remission or low disease activity at conception maintained significantly lower disease activity throughout gestation and in the early postpartum period compared with patients presenting moderate or high activity in the first trimester (p = 0.0008–0.04). Similarly, women without arthritis at conception showed lower RA activity during pregnancy.

In 23 patients (71.9%) who exhibited disease activity during gestation, intensification of anti-inflammatory therapy resulted in a significant decrease in DAS28–CRP (p = 0.008). Conversely, 9 patients (28.1%) with low activity who did not receive intervention showed a tendency toward increased disease activity. Postpartum, patients with moderate or high activity resumed therapy earlier, which facilitated quicker improvement (p = 0.008), while those with low activity during pregnancy experienced a delayed increase in RA activity lasting up to three months. In 12 patients (37.5%) who discontinued basic anti-inflammatory (HDL) or genetically engineered biological therapy (GIBP) due to unplanned pregnancy, disease activity during the first to third trimesters was significantly higher than in 20 patients (62.5%) who either did not use these drugs or discontinued them prior to conception (p < 0.04).

Remission or low RA activity at conception predicts lower disease activity and allows for minimal or no pharmacological therapy during pregnancy. Without medical intervention, RA activity may increase. Postpartum exacerbations are common, even in patients with prior low activity, emphasizing the need for careful monitoring. Abrupt discontinuation of HDL or GIBP in unplanned pregnancies is associated with early gestational increases in RA activity. Planned pregnancy with stable anti-inflammatory therapy is recommended to optimize maternal disease control.