FRI0054 Risk factors for postpartum flare in rheumatoid arthritis – a romanian cohort

Background

Patients diagnosed with rheumatoid arthritis (RA) before pregnancy may experience a postpartum flare. This event may occur independently of the patient treatment, according to recent guidelines.¹

Objectives

The aim of this study was to identify possible risk factors of postpartum RA flares.

Methods

We analysed pregnant RA patients treated with b DMARDs pre-conception/during pregnancy which delivered children. Data analysis was performed in a combined maner : prospectively and retrospectively. Data collection was focused on 5 distinct periods of time: pre-conception, 1 st, 2nd, 3rd pregnancy trimesters, postpartum period before 12 weeks and after 12 weeks. Following parameters were analysed: demographic data (type of pregnancy- planned/unplanned), immunology (RF and ACPA positivity), disease activity score DAS-CRP,² type of medication and duration. Subfertility status and postpartum flares were registered. The retrospective analysis was represented by interview collected data. Flare was defined as early (<12 weeks postpartum) or late >12 weeks)

Results

Among 96 pregnant patients, 54 (56%) patients delivered 57 children. Out of 54 patients, 17 (31.5%) were analysed prospectively and 37, 68.5% retrospectively. The patients were exposed to 3 types of b DMARDs: TNF blockers,⁹ Rituximab⁵ and Tocilizumab.¹Rituximab was stopped before pregnancy in 4 out of 5 patients (1 continued therapy during the 1 st trimester- unplanned pregnancy) and all presented a postpartum flare. Out of 9 patients with TNF blocker therapy, 2 of them stopped the drug before pregnancy and the other 7 used the medication until pregnancy test positivity or until the end of the 2nd trimester. In this group, 6 of 9 patients presented a postpartum flare. One patient was treated with Tocilizumab before pregnancy and experienced an early flare. table 1 presents the analysis of a set of collected parameters. Overall, the majority of the patients (77.8%) experienced a postpartum flare. An early postpartum flare was identified in 53.7% and late one in 24.1%, with a mean value of 11.59±9.45 weeks. The prospective group experienced more frequently an early flare in comparison to group 2 (0.244 (95% CI 0.62–0.965) but without statistic significance. A positive correlation was found between active disease during the ²nd and 3rd trimester and postpartum early flare occurrence (p=0.044). No correlation was found between postpartum flare, fertility status or therapy type and duration.

Conclusions

RA pregnant patients treated with b DMARDs experience a postpartum flare in the majority of the cases. Persistent active disease during the second and third trimester was identified as a risk factor for postpartum disease flare. Larger prospective studies are neede in order to make a better analysis of all evaluated parameters.

References

[1] Julia flint et all. BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding. Rheumatology2016;55(9). [2] Yaël A de Man, Johanna MW Hazes, Fleur E van de Geijn, Catharina Krommenhoek, Radboud JEM Dolhain. Measuring disease activity and functionality during pregnancy in patients with rheumatoid arthritis. Arthritis & Rheumatism57:716–722. doi:10.1002/art.22773

Disclosure of Interest

None declared