Postpartum follow-up of women with JIA warranted
medwireNews: The majority of women with juvenile idiopathic arthritis (JIA) maintain stable disease activity during and after pregnancy, but some patients experience a small increase in disease activity following childbirth, research suggests.
The study used data from a Norwegian registry including 114 women with JIA who were aged a median of 29 years and had a median disease duration of 20 years.
Kristin Ursin, from Trondheim University Hospital, Norway, and study co-authors analyzed Disease Activity Score at 28 joints based on C-reactive protein 3 (DAS28-CRP3) scores at seven timepoints before, during, and after pregnancy, and found that almost 80% of women were in remission or had low disease activity (DAS28-CRP3 of ≤2.6 and >2.6 to ≤3.2 points, respectively) from the preconception stage to 1 year after delivery.
Overall, disease activity was “low and relatively stable” over the study period, despite the proportion of women using DMARDs decreasing from 55% in the year before conception to 22% during pregnancy, report Ursin and colleagues in The Journal of Rheumatology.
However, mean DAS28-CRP3 scores at 6 weeks after delivery were significantly higher than those during the first and third trimesters of pregnancy, at 2.78 versus 2.51 and 2.56 points, giving a difference of 0.27 and 0.22 points, respectively.
Although a change in DAS28-CRP3 score of at least 1.2 points is usually considered the cutoff for a clinically significant difference, the researchers note that the percentage of women who were in remission also decreased from 72% during the first trimester to 53% at 6 weeks postpartum, suggesting that the observed increase in disease activity “is clinically relevant despite the small change in estimated mean DAS28.”
This “small but significant increase in disease activity 6 weeks postpartum calls for tight followup of women with JIA in the first weeks after delivery,” they write.
Ursin et al caution that their findings may not be generalizable to other healthcare systems that have less focus on pregnancy planning among women with rheumatic diseases, and that information on JIA subtypes was not available.
“Future research on pregnancy in subgroups of JIA would be of interest,” they conclude.
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