FRI0054 Risk factors for postpartum flare in rheumatoid arthritis – a romanian cohort
Authors: A. Bobirca, F. Bobirca, I. Ancuta, M. Micu, C. Ancuta, M. Bojinca, C. Mihai, V. Stoica
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> 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.<sup>1</sup> <h3>Objectives</h3> The aim of this study was to identify possible risk factors of postpartum RA flares. <h3>Methods</h3> 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,<sup>2</sup> 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 (&lt;12 weeks postpartum) or late &gt;12 weeks) <h3>Results</h3> 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,<sup>9</sup> Rituximab<sup>5</sup> and Tocilizumab.<sup>1</sup>Rituximab 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 <sup>2</sup>nd 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. <h3>Conclusions</h3> 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. <h3>References</h3> [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 &amp; Rheumatism57:716–722. doi:10.1002/art.22773 <h3>Disclosure of Interest</h3> None declared