AB0804 PREGNANCY AND PSORIATIC ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW OF DISEASE ACTIVITY AND ADVERSE PREGNANCY OUTCOMES
Authors: Y. Meißner, T. Rudi, R. Fischer-Betz, A. Strangfeld
Journal: Annals of the Rheumatic Diseases (2020)

Background: There is little robust evidence on the course of pregnancy and its outcomes in women with psoriatic arthritis (PsA) on which recommendations for the management of these patients could be based. Objectives: To review available data on disease activity during pregnancy and adverse pregnancy outcomes in women with PsA. Methods: Systematic literature search within the databases Pubmed and Embase using the keywords ‘psoriatic arthritis’ and ‘pregnan*/ obstetr*/ matern*/ gestation*/ deliver*/ abortion*/ reproduct*/ birth/ parity’. All full text articles published until 31 Dec 2019 were systematically evaluated by 2 reviewers. All studies including at least 5 pregnant PsA patients and reporting on disease activity and/or obstetric outcomes were considered. Results: The review of 592 search results revealed 13 eligible publications reporting on a total of 2332 pregnancies in PsA. Nine studies reported disease activity during and after pregnancy using differing instruments (table 1). Three of them reported an increase in the proportion of women with moderate to severe activity postpartum compared to pregnancy. Another 3 studies described a worsening of the arthritis in 15-32% and in the psoriatic activity in 4-9% of patients during pregnancy and postpartum in 33-50% and 27-43% of patients, respectively. Table 1. Study characteristics Study Data source No. of pregnancies Disease activity instruments Berman, 2018 Hospital records 35 Synovitis Bröms, 2018 National registries 964 - Eudy, 2019 Hospital records + questionnaires 37 Patient reported arthritis + psoriatic activity Mork, 2019 National registries 130 - Mouyis, 2017 Hospital records 16 Physician global activity Murray, 2019 Hospital cohort* 18 DAS28-CRP3 Ostensen, 1988 Hospital cohort* 12 Composite score Polachek, 2017 Hospital cohort* 42 SJC/ TJC, PASI Polachek, 2019 Hospital cohort + questionnaires 151 Patient reported PsA activity Remaeus, 2019 National registries 541 - Smith, 2019 Cohort* 117 HAQ, RAPID3 Strouse, 2019 Claims data 161 - Ursin, 2019 Cohort* 108 DAS28, BASDAI *Prospective study Adjusted analyses did not show an increased risk for gestational diabetes, small for gestational age (SGA) and low birth weight (LBW) in PsA patients (table 2). However, estimates for other obstetric outcomes diverged. Table 2. Obstetric outcomes Study Comparator: Pregnant women without ... Repor-ted as (Pre-) Eclampsia Gesta-tional diabetes Elective Caesarean section Preterm birth SGA LBW Bröms ... psoriasis HR 1.49 (1.08-2.05 ) 1.21 (0.79-1.87) 1.47 (1.18-1.81 ) 1.25 (0.94-1.65) 0.72 (0.42-1.22) 1.07 (0.75-1.52) Mork ... Spondyloarthritis OR 1.03 (0.23-4.57) - 1.01 (0.47-2.19) 1.24 (0.54-2.83) 1.72 (0.98-3.02) - Remaeus ... PsA HR 1.21 (0.78-1.88) 1.26 (0.54-2.94) 1.47 (1.10-1.97 ) 1.63 (1.17-2.28 ) 1.06 (0.61-1.84) - Smith ... auto-immune/ other chronic diseases RR 2.22 (0.98-5.04) 1.41 (0.70-2.87) - 1.69 (0.94-3.03) - 1.52 (0.76-3.04) Strouse ... rheumatic diseases HR - - - 1.77 (1.15-2.73 ) 1.24 (0.75-2.06) - Abbreviation: HR, Hazard ratio; OR, Odds ratio; RR, risk ratio. Conclusion: Individual studies showed a trend towards increased disease activity after pregnancy in PsA patients but due to the heterogeneity of the instruments used, it is difficult to summarise the single results. No signal for specific adverse pregnancy outcomes was identified. However, a higher risk for (pre)eclampsia, elective caesarean section and preterm birth cannot be ruled out. Differences in studies (e.g. primary vs secondary data) limit statements on obstetric outcomes. Harmonization of approaches and instruments is crucial in order to enable future joint data analyses and meta-analyses. In particular, a standardised instrument for assessing disease activity of PsA that takes into account the particularities of pregnancy is needed. Funding: This work was supported by a research grant from FOREUM Foundation for Research in Rheumatology. Disclosure of Interests: Yvette Meißner Speakers bureau: Pfizer, Tatjana Rudi: None declared, Rebecca Fischer-Betz Consultant of: UCB, Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celgene, Chugai, GSK, Janssen, Lilly, Medac, MSD, Novartis, Roche, UCB, Pfizer., Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis