Active Psoriatic Arthritis during pregnancy may Increase Risk of Hypertensive Pregnancy Disorders: BMJ

A Norwegian study published in the journal of RMD Open: Rheumatic & Musculoskeletal Diseases found that women with active psoriatic arthritis (PsA) during pregnancy face a significantly higher risk of developing hypertensive disorders such as pre-eclampsia and gestational hypertension, when compared to both women with inactive PsA and the general population. However, no increased risk was found for preterm birth or fetal growth abnormalities.

This research from 2010 to 2019, utilized data from the RevNatus registry and linked it with the Medical Birth Registry of Norway (MBRN). The study included 109 singleton births among women with PsA and compared them with 575,798 population controls recorded during the same period.

To assess disease activity, this research applied the Disease Activity Score based on 28 joints using C-reactive protein (DAS28-CRP) during the second and third trimesters. Women with scores of DAS28-CRP ≥2.6 were classified as having active PsA (n=34), while the individuals with scores below 2.6 were considered to have inactive PsA (n=75).

Pre-eclampsia which is characterized by high blood pressure and potential organ damage, was notably more common among women with active PsA. The study reported 8.8% of women in this group (3 out of 34) developed pre-eclampsia, when compared with 2.6% in the general population. This difference translated to a 6.1% higher risk (95% confidence interval [CI]: 0.3–20.3; p=0.036).

Similarly, gestational hypertension occurred in 5.9% of women with active PsA (2 out of 34) versus 1.7% in the general population, which showed a 4.2% higher risk (95% CI: 0.0–17.4; p=0.065). In contrast, women with inactive PsA showed no meaningful increase in hypertensive disorders. Among them, 1.3% experienced pre-eclampsia (p=0.59) and 2.7% developed gestational hypertension (p=0.24), rates comparable to those seen in the population controls.

When examining preterm birth and abnormal fetal growth, no significant differences were found between women with either active or inactive PsA and those in the control group. This suggests that while PsA activity may elevate maternal risk for hypertension-related conditions, it does not appear to affect fetal outcomes like early delivery or restricted growth.

Overall, the findings of this study highlights the importance of disease activity management during pregnancy for women with PsA. Maintaining low disease activity appears crucial not only for maternal health but also for minimizing the risk of pregnancy complications.

Reference:

Gotestam Skorpen, C., Lydersen, S., Salvesen, K. Å., & Wallenius, M. (2025). Pre-eclampsia is more common in women with active psoriatic arthritis in pregnancy: a population-based study. RMD Open, 11(4), e005666. https://doi.org/10.1136/rmdopen-2025-005666