Factors Associated With Time to Pregnancy in Women With Axial Spondyloarthritis: A Registry-Based Multicenter Study.

OBJECTIVE: The present study was undertaken to study time to pregnancy (TTP) and factors associated with TTP in women with axial spondyloarthritis (SpA) compared to women with rheumatoid arthritis (RA). METHODS: We included 274 women with axial SpA and 317 women with RA from the Norwegian nationwide registry RevNatus. For all the women, we had retrospectively collected data on TTP, and a subgroup also had prospectively collected data. We compared TTP in women with axial SpA to women with RA using Kaplan-Meier plots and a log rank test. To identify factors associated with TTP, we used Cox proportional hazards regression. RESULTS: TTP exceeded 12 months in 21% of women with axial SpA. In the subgroup followed prospectively, 32% had TTP that exceeded 12 months. Longer TTP was associated with older age, nulliparity, and longer disease duration, with hazard ratios of 0.97 (95% confidence interval [95% CI] 0.94-1.00), 0.66 (95% CI 0.50-0.88), and 0.94 (95% CI 0.91-0.98), respectively. Disease activity, medication, and self-reported health-related quality of life were not associated with TTP. We found no statistically significant differences between axial SpA and RA in regard to TTP. CONCLUSION: In women with axial SpA, longer TTP was associated with older age, nulliparity, and longer disease duration.

Psoriatic Arthritis Disease Activity During and After Pregnancy: A Prospective Multicenter Study.

OBJECTIVE: To study disease activity in women with peripheral psoriatic arthritis (PsA) during and after pregnancy. Previous knowledge on this topic is sparse. METHODS: The study included 108 pregnancies in 103 women with PsA from a Norwegian nationwide register. Disease activity was assessed prospectively at 7 time points before, throughout, and after pregnancy with the 3-variable Disease Activity Score in 28 joints (DAS28) using C-reactive protein levels and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Scores assessed at each time point were analyzed in a linear mixed model. We did additional analyses with "tumor necrosis factor inhibitor (TNFi) in pregnancy" as a covariate. The same statistical method was used to study self-reported physical function, pain, and mental health. RESULTS: Approximately 75% of the women were in remission or had low disease activity during and after pregnancy according to the DAS28-CRP score. Although disease activity was altogether stable, we found that it decreased in pregnancy and increased within 6 months postpartum. Disease activity at 6 months postpartum was significantly higher than at 6 weeks postpartum (mean DAS28-CRP score 2.71 versus 2.45; P = 0.016). Women using TNFi in pregnancy had significantly lower disease activity than women not using TNFi (mean DAS28-CRP score at 6 months postpartum 2.22 versus 2.72; P = 0.043). BASDAI scores were also low and stable during pregnancy but significantly higher at 6 months postpartum than at 6 weeks postpartum (mean BASDAI score 3.69 versus 2.95; P = 0.013). CONCLUSION: Studying women with PsA, we found that disease activity was highest at 6 months postpartum but altogether low and stable in the period from planning pregnancy to 1 year after delivery. Women using TNFi in pregnancy had significantly lower disease activity.

Disease activity during and after pregnancy in women with axial spondyloarthritis: a prospective multicentre study.

Objective: The aim was to study disease activity in women with axial spondyloarthritis (axSpA) during and after pregnancy. Methods: The study included 179 pregnancies in 166 women with axSpA from a Norwegian nationwide register. Disease activity was assessed at seven time points before, throughout and after pregnancy with the DAS BASDAI. Scores assessed at each time point were analysed in a linear mixed model. The same statistical method was used to study self-reported physical functioning, pain and mental health. Results: Altogether, disease activity was stable throughout the study period. We found the highest disease activity and worst self-reported pain in the second trimester, when 45% of the women had active disease. At this time point, disease activity was significantly higher than 6 weeks postpartum (mean BASDAI 3.97 vs 3.46, P = 0.005). Self-reported mental health was also stable, but significantly better 6 weeks postpartum than in the first trimester (mean RAND-36 mental health 79.3 vs 73.2, P < 0.001). Physical functioning was significantly worse in third trimester than postpartum (mean BASFI 3.6 vs 2.6, P < 0.001). Conclusion: Studying women with axSpA, we found that disease activity was highest in the second trimester, but altogether low and stable in the period from planning pregnancy to 1 year after delivery.

Disease Activity of Juvenile Idiopathic Arthritis during and after Pregnancy: A Prospective Multicenter Study.

OBJECTIVE: To study disease activity in women with juvenile idiopathic arthritis (JIA) during and after pregnancy. There is little previous knowledge about this topic. METHODS: Our study included 135 pregnancies in 114 women with JIA. Disease activity was assessed at 7 timepoints before, throughout, and after pregnancy with the Disease Activity Score-28-C-reactive protein 3 (DAS28-CRP3). Scores assessed at each visit were analyzed in a linear mixed model. The same statistical method was used to study self-reported physical function, pain, and mental health. RESULTS: Almost 80% of the women were in remission or had low disease activity during and after pregnancy. Although disease activity was stable throughout the study period, we found that DAS28 6 weeks postpartum increased significantly compared to the first trimester (2.78 vs 2.51, p = 0.005) and third trimester (2.78 vs 2.56, p = 0.011), respectively. DAS28 decreased significantly between 6 weeks and 12 months postpartum (2.78 vs 2.54, p = 0.014). Self-reported mental health was significantly better 6 weeks postpartum than before pregnancy (Medical Outcomes Study Short Form-36 Mental Health subscale 80.7 vs 76.5, p = 0.039). Self-reported pain was stable. Physical function was significantly worse in the third trimester of pregnancy than postpartum (Modified Health Assessment Questionnaire 0.57 vs 0.39, p < 0.001). CONCLUSION: In women with JIA, disease activity was highest 6 weeks postpartum, but altogether low and stable in the period from planning pregnancy to 1 year after delivery.