FRI0655 THE IMPACT OF PREGNANCY ON STRUCTURAL PROGRESSION IN PREMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS
Authors: Deshire Alpizar-Rodriguez, Frauke Förger, Axel Finckh
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Disease activity often improves during pregnancy and worsens at the postpartum period [1]. The long-term effect of pregnancy on radiographic joint damage progression among premenopausal women with RA has been barely studied. <h3>Objectives</h3> The aim of this study was to analyse the impact of pregnancy on radiographic progression in premenopausal women with RA. <h3>Methods</h3> This is an observational cohort study of RA patients included in the Swiss Clinical Quality Management in Rheumatoid Arthritis (SCQM-RA). Patients enrolled are followed-up yearly and have radiographic assessments at regular intervals. Information about female reproductive factors, such as pregnancies, breastfeeding and hormonal treatment were retrospectively retrieved using a questionnaire. For this analysis we included premenopausal women with at least two radiographic assessment and full information on reproductive factors. The primary outcome was the rate of radiographic progression (Ratingen erosion score). We analysed the radiographic progression between premenopausal women with at least one pregnancy and those with no pregnancies. Baseline time was the first radiographic assessment. We used a multilevel regression model for longitudinal data, adjusted for potential confounders, such as baseline age, disease duration, DAS-28 and treatment. <h3>Results</h3> Among 1966 women who were interviewed, 430 premenopausal women with sequential radiographic assessments during follow-up were analysed. Half of premenopausal women had at least one pregnancy. Women with at least one pregnancy were older than nulliparous (median of 41 vs 36 years, p&lt;0.001) and had longer disease duration (median of 3.4 vs 2.6 years, p=0.04) (Table 1). During follow-up, the rate of radiographic progression was lower in women with pregnancies than in nulliparous women [(0.9% (95% CI: 0.0 to 1.9) vs 2.1% (95% CI: 0.9 to 3.1) over 10 years, respectively, p=0.04, Figure 1]. In a sub-analysis, the rate of radiographic progression appeared to be lower during the 13-year period after first pregnancy than after this period [(0.2% (95% CI: -0.8 to 1.3) vs 2.6% (95% CI: 1.3 to 3.9) over 13 years, respectively, p=0.003]. We found no difference in the rate of radiographic progression between women with a single pregnancy and multiparous women. <h3>Conclusion</h3> In premenopausal women with RA, joint damage progressed more rapidly in nulliparous women than in women with at least one pregnancy. However, we cannot make any definite causal inference, since it is well possible that women renouncing getting pregnant might be patients with more severe disease. Radiographic progression appeared to increase the longer the time since pregnancy. <h3>References</h3> [1] Ince-Askan H, et al. J Rheumatol2016;43 :22-5. <h3>Disclosure of Interests</h3> Deshire Alpizar-Rodriguez: None declared, Frauke Förger: None declared, Axel Finckh Grant/research support from: Bristol-Myers Squibb, Pfizer Inc, Consultant for: AbbVie, A2Bio, Bristol-Myers Squibb, MSD, Roche, Pfizer Inc, and UCB