Pregnant women with psoriatic arthritis have increased pre-eclampsia risk: BMJ

Pregnancies with psoriatic arthritis (PsA), but not with axial spondyloarthritis (AxSpA), had an elevated risk of pre-eclampsia, says an article published in BMJ - Rheumatic & Musculoskeletal Disease.

Women are affected by RA, AxSpA, and PsA during their reproductive years. Previous research has found links between these illnesses and negative pregnancy outcomes such as preterm delivery, small for gestational age, and cesarean sections. Concerns have been raised about the possible influence of disease activity and medication usage during pregnancy. As a result, Anne Emilie Pape Secher and colleagues undertook this study to investigate the risk of pre-eclampsia in rheumatoid arthritis (RA), axial spondyloarthritis, and psoriatic arthritis, with a focus on the influence of therapy and disease activity.

Medical birth registrations were linked to Swedish (SRQ) and Danish (DANBIO) rheumatology registers to identify RA, AxSpA, and PsA singleton pregnancies (2006-2018). Maternal age, parity, and birth year were matched 1:10 in control pregnancies from medical birth registries. Before and during pregnancy, information on antirheumatic therapy and disease activity was gathered. The risks of pre-eclampsia in RA, AxSpA, and PsA pregnancies were estimated overall and by antirheumatic treatment and disease load using logistic regression (aORs with 95% CI).

The key findings of this study were:

1. Researchers identified 69, 34, and 26 pre-eclampsia episodes among RA (n=1739), AxSpA (n=819), and PsA (n=489) patients, resulting in an aOR of 1.27, 1.17 (0.76 to 1.78), and 1.85 (1.10 to 3.12), respectively, compared to controls.

2. Maternal combination medication before and throughout pregnancy was linked to an increased incidence of RA (1.59; 1.07 to 2.37 and 1.53; 0.97 to 2.39, respectively).

3. In the case of PsA, maternal monotherapy prior to pregnancy was linked to pre-eclampsia (2.72; 1.4 to 5.13).

4. High disease burden was related with a twofold incidence of pre-eclampsia in RA pregnancies with accessible information (43%).

In conclusion, from a therapeutic standpoint, the findings of this study contribute to the body of knowledge by educating doctors about the underlying risk of pre-eclampsia in these patient categories and stressing the significance of monitoring women with RA and PsA for this risk.

Reference: 

Secher, A. E. P., Granath, F., Glintborg, B., Rom, A., Hetland, M. L., & Hellgren, K. (2022). Risk of pre-eclampsia and impact of disease activity and antirheumatic treatment in women with rheumatoid arthritis, axial spondylarthritis and psoriatic arthritis: a collaborative matched cohort study from Sweden and Denmark. In RMD Open (Vol. 8, Issue 2, p. e002445). BMJ. https://doi.org/10.1136/rmdopen-2022-002445