We have little knowledge on what happens to psoriatic arthritis patients during pregnancy. Do the joints flare? What about the skin? Can we extrapolate the rheumatoid arthritis experience to psoriatic arthritis? Furthermore, we don't know if psoriatic arthritis is associated with adverse effects on pregnancy. Are women with PsA more likely to have pregnancy-associated morbidity?
This morning at EULAR, Megan Clowse presented some data on pregnancy in psoriatic arthritis. This is the most comprehensive information I have seen. She surveyed 40 women with psoriatic arthritis. These may not be reflective of our populations, as they were largely white (93%), and well educated (40% completed college) with a mean age of 37.4 years.
There were 70 pregnancies in 26 patients, 37 of which occurred after the diagnosis of psoriatic arthritis. The majority of patients (76%) did not take immune suppressants during pregnancy, and those who did took TNFi (16%), corticosteroids (8%) and DMARDs (5%).
Of the 40 women surveyed, there was a high rate of infertility (36%) in those who had ever tried to become pregnant, most commonly due to polycystic ovarian syndrome (44%).
Pregnancy Effect on Psoriatic Arthritis
Joint disease was either stable or improved, and only worsened in about one quarter of patients. Skin disease, on the other hand, seemed to improve overall, and only worsened in around 6%. There were no significant post-partum flares.
Psoriatic Arthritis Effect on Pregnancy
When comparing pregnancies before and after the diagnosis of PsA, those that occurred after a diagnosis of PsA had significantly higher rates of pregnancy loss, preterm birth and pre-eclampsia. It is unclear if this is due to older age, associated metabolic syndrome or the disease itself.
At the end of the day, I think this data shows us that psoriatic arthritis is quite different than rheumatoid arthritis with regards to reproduction. We should be aware of the high rates of infertility, and perhaps we should counsel women with PsA about earlier pregnancies. We can reassure patients that their disease will likely be stable throughout pregnancy with low risk of post-partum flares. We should monitor patients closely for negative pregnancy-associated outcomes, and minimize other risk factors. This is just the beginning…. More data is still needed.
Dr. Jamal is a Clinical Associate Professor at the University of British Columbia and an active staff physician at Vancouver Coastal Health. Her interests include diagnosis and prognosis of early inflammatory arthritis, and timely assessment and access to care for patients with rheumatoid arthritis.View Full Bio