Literature Review Explores Pregnancy Outcomes in Women with Psoriatic Arthritis

A systematic literature review has reported on outcomes in pregnant women with psoriatic arthritis (PsA). The review primarily explored disease activity during pregnancy course and adverse pregnancy outcomes, thus finding a general worsening of disease following delivery.

The study was conducted by investigators from the German Rheumatism Research Centre Berlin. Led by Yvette Meissner, MSc, the investigative team searched within the Pubmed and Embase databases for relevant literature on psoriatic arthritis pregnancy outcomes through November 2020.

“Recommendations for the use of disease-modifying anti-rheumatic drugs (DMARDs) in pregnant and lactating women with rheumatic diseases have been published, but information on disease activity during pregnancy and adverse pregnancy outcomes in women with PsA are still scarce,” they noted.

In addition to maternal outcomes, the team evaluated neonatal outcomes during gestation.

The Study

Meissner’s team evaluated 13 relevant publications, which consisted of 2332 pregnancies in women affected by PsA. All studies reported on disease activity and/or pregnancy outcomes.

Furthermore, 5 studies prospectively followed patients, and 8 were retrospective. A majority (n = 7) reported on data based on single center hospital records or cohorts. The analysis also included data from Scandinavian national registries and a United States birth registry.

All studies were published between 2017-2020, save for one that was published in 1988.

The mean or median age range across studies was from 29 – 34 years.

Highlights

Thus, 9 studies reported disease activity during pregnancy—representing a total of 536 pregnancies.

Additionally, a majority of PsA patients in each study was classified with mild/low disease activity. Up to 1/3 of patients reported a moderate to severe/high disease activity.

However, one such study reported moderate or severe PsA in 8 of 14 pregnant patient.

“Throughout the studies, disease activity deteriorated postpartum compared to the pregnancy period,” the investigators wrote. “In addition, 3 studies reported worsening of arthritis and psoriatic skin involvement after birth in a considerable proportion of patients.”

Adverse pregnancy outcomes were reported in 9 studies representing 2135 pregnancies in women with PsA.

Outcomes, although of various rates for each study, included pre-eclampsia, preterm birth, gestational diabetes, small for gestational age, and low birth weight. However, none of the studies found an increased risk for the latter 4 outcomes.

The investigators noted the considerable inconsistencies in risk for adverse pregnancy outcomes, particularly for caesarean section and low birth weight.

And finally, there were no reported increased risks for adverse neonatal outcomes in this maternal patient population.

Conclusion

Some of the limitations acknowledged by the investigators were the heterogeneity of study designs and differences in PsA activity assessments, such as use of Disease Activity Score based on 28 tender and swollen joints and C-reactive protein (DAS28-CRP3), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Routine Assessment of Patient Index Data (RAPID3), and Health Assessment Questionnaire (HAQ), for example.

Additionally, not all studies were entirely forthcoming and clear about methodologies (i.e. time point of patient enrollment).

“To enable informed counselling of patients with PsA before, during and after pregnancy, future research should address the development of standardised instruments for assessing disease activity in PsA during pregnancy, the investigation of the interplay between pregnancy in PsA and effect of DMARD treatment on the course of PsA, pregnancy and the development of the foetus,” Meissner and colleagues concluded.

The study, “Pregnancy in women with psoriatic arthritis: A systematic literature review of disease activity and adverse pregnancy outcomes,” was published online in Seminars in Arthritis and Reumatism.