FRI0569 WHAT DOES IT MEAN TO BECOME PREGNANT WITH JUVENILE IDIOPATHIC ARTHRITIS? A MONOCENTRIC EXPERIENCE IN A TERTIARY CENTRE OF MILAN DEDICATED TO YOUNG ADULTS AFFECTED BY JIA
Authors: Irene Pontikaki, Maria Gerosa, Lorenza Maria Argolini, Carolina Artusi, Martina Cornalba, Laura Trespidi, Pier Luigi Meroni
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> During the last seventeen years, biological and non-biological therapies have been used in our center in an open prospective study for the treatment of refractory JIA not only in paediatric age but also in young adults. The availability of more effective drugs for JIA has dramatically increased the number of patients willing to become pregnant. Data regarding the effect of JIA on pregnancy outcome are scant. <h3>Objectives</h3> The study aims to evaluate the capability of JIA patients to become pregnant, the effects of drugs on pregnancy outcome and the impact of gestation on the disease course. <h3>Methods</h3> JIA patients regularly followed up in our Transition Clinic of the Division of Rheumatology, Gaetano Pini Institute of Milan, were enrolled in the study at positive pregnancy test. During the whole pregnancy patients underwent monthly clinical examination and obstetric ultrasound. Data regarding disease activity and pregnancy course (fetal morphometric parameters, fetal heart rate, fetal growth, Doppler velocimetry) were collected. Gestational age, birth weight and APGAR score were also recorded. <h3>Results</h3> 29 pregnancies in 23 women affected by refractory JIA became pregnant during a 17 years follow up. All patients had a long lasting polyarticular disease (median duration of 23 years) not responsive to DMARDs, and became pregnant during biologic therapy. Patients were treated with Etanercept (11 patients), Golimumab (4 patients), Rituximab (3 patients), Adalimumab and Certolizumab (2 patients respectively) as monotherapy, and in most of the cases after multiple switches. One woman was treated with Etanercept during the first pregnancy and Adalimumab during her second pregnancy. Three patients decided for an elective termination and 3 experienced an early miscarriage; among 23 pregnancies resulting in live born infants, only 3 had premature births and 1 cleft palate. A pregnancy was complicated by gestosis, two by placental detachment. All the babies were followed up during the 17 years of observation and did not experience any major late complication. Eight patients were subjected to intra-articular infiltrations during pregnancy to switch off the disease, 18 patients resumed therapy shortly after childbirth and only 7 patients decided to breastfeed. Conclusion: despite a large amount of studies demonstrating the safety of anti-TNF during pregnancy, data regarding the effects of biologics on pregnancy outcome in JIA are still lacking. The very low number of patients treated with traditional DMARDs achieving low disease activity underline the pivotal role of new biologic drugs in the management of aggressive long standing JIA, to improve the quality of life of these patients, including family planning. In our experience, no greater number of unexpected complications or side effects were observed in JIA patients during pregnancy compared to the other autoimmune diseases. Discontinuation of therapy has increased the risk of flare, requiring local therapy, confirming that EULAR recommendations for the use of biologics during pregnancy can be applied also in JIA. <h3>References</h3> [1] Bazzani C, et al. Prospectively-followed pregnancies in patients with inflammatory arthritis taking biological drugs: an Italian multicentre study. Clin Exp Rheumatol. 2015Sep-Oct;33(5):688-93. Epub 2015 Aug 25. <h3>Disclosure of Interests</h3> Irene Pontikaki: None declared, Maria Gerosa: None declared, Lorenza Maria Argolini: None declared, Carolina Artusi: None declared, Martina Cornalba: None declared, Laura Trespidi: None declared, Pier Luigi Meroni Consultant for: Inova, Thermofisher, Teofarma